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Colorectal cancer - Wikipedia
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class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Pathogenesis"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Pathogenesis</span> </div> </a> <button aria-controls="toc-Pathogenesis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Pathogenesis subsection</span> </button> <ul id="toc-Pathogenesis-sublist" class="vector-toc-list"> <li id="toc-Field_defects" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Field_defects"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>Field defects</span> </div> </a> <ul id="toc-Field_defects-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Epigenetics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Epigenetics"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span>Epigenetics</span> </div> </a> <ul id="toc-Epigenetics-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Genomics_and_epigenomics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Genomics_and_epigenomics"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Genomics and epigenomics</span> </div> </a> <ul id="toc-Genomics_and_epigenomics-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Medical_imaging" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medical_imaging"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Medical imaging</span> </div> </a> <ul id="toc-Medical_imaging-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Histopathology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Histopathology"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.2</span> <span>Histopathology</span> </div> </a> <ul id="toc-Histopathology-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Staging" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Staging"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.3</span> <span>Staging</span> </div> </a> <ul id="toc-Staging-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Prevention</span> </div> </a> <button aria-controls="toc-Prevention-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Prevention subsection</span> </button> <ul id="toc-Prevention-sublist" class="vector-toc-list"> <li id="toc-Lifestyle" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Lifestyle"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Lifestyle</span> </div> </a> <ul id="toc-Lifestyle-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Medication_and_supplements" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Medication_and_supplements"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Medication and supplements</span> </div> </a> <ul id="toc-Medication_and_supplements-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Screening" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Screening"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3</span> <span>Screening</span> </div> </a> <ul id="toc-Screening-sublist" class="vector-toc-list"> <li id="toc-Recommendations" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Recommendations"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3.1</span> <span>Recommendations</span> </div> </a> <ul id="toc-Recommendations-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Surgery" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Surgery"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>Surgery</span> </div> </a> <ul id="toc-Surgery-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Chemotherapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Chemotherapy"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>Chemotherapy</span> </div> </a> <ul id="toc-Chemotherapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Radiation_therapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Radiation_therapy"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.3</span> <span>Radiation therapy</span> </div> </a> <ul id="toc-Radiation_therapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Immunotherapy" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Immunotherapy"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.4</span> <span>Immunotherapy</span> </div> </a> <ul id="toc-Immunotherapy-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Palliative_care" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Palliative_care"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.5</span> <span>Palliative care</span> </div> </a> <ul id="toc-Palliative_care-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Psychosocial_Intervention" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Psychosocial_Intervention"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.6</span> <span>Psychosocial Intervention</span> </div> </a> <ul id="toc-Psychosocial_Intervention-sublist" class="vector-toc-list"> <li id="toc-Depression_and_Anxiety" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Depression_and_Anxiety"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.6.1</span> <span>Depression and Anxiety</span> </div> </a> <ul id="toc-Depression_and_Anxiety-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Post-Treatment_Distress" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Post-Treatment_Distress"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.6.2</span> <span>Post-Treatment Distress</span> </div> </a> <ul id="toc-Post-Treatment_Distress-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Stigma" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Stigma"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.6.3</span> <span>Stigma</span> </div> </a> <ul id="toc-Stigma-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Methods_of_Intervention" class="vector-toc-list-item vector-toc-level-3"> <a class="vector-toc-link" href="#Methods_of_Intervention"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.6.4</span> <span>Methods of Intervention</span> </div> </a> <ul id="toc-Methods_of_Intervention-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Follow-up" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Follow-up"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.7</span> <span>Follow-up</span> </div> </a> <ul id="toc-Follow-up-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Exercise" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Exercise"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.8</span> <span>Exercise</span> </div> </a> <ul id="toc-Exercise-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prognosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prognosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Prognosis</span> </div> </a> <button aria-controls="toc-Prognosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Prognosis subsection</span> </button> <ul id="toc-Prognosis-sublist" class="vector-toc-list"> <li id="toc-Recurrence_rates" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Recurrence_rates"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.1</span> <span>Recurrence rates</span> </div> </a> <ul id="toc-Recurrence_rates-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Survival_rates" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Survival_rates"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.2</span> <span>Survival rates</span> </div> </a> <ul id="toc-Survival_rates-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>Epidemiology</span> </div> </a> <button aria-controls="toc-Epidemiology-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Epidemiology subsection</span> </button> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> <li id="toc-United_States" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#United_States"> <div class="vector-toc-text"> <span class="vector-toc-numb">8.1</span> <span>United States</span> </div> </a> <ul id="toc-United_States-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-United_Kingdom" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#United_Kingdom"> <div class="vector-toc-text"> <span class="vector-toc-numb">8.2</span> <span>United Kingdom</span> </div> </a> <ul id="toc-United_Kingdom-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Australia" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Australia"> <div class="vector-toc-text"> <span class="vector-toc-numb">8.3</span> <span>Australia</span> </div> </a> <ul id="toc-Australia-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Papua_New_Guinea" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Papua_New_Guinea"> <div class="vector-toc-text"> <span class="vector-toc-numb">8.4</span> <span>Papua New Guinea</span> </div> </a> <ul id="toc-Papua_New_Guinea-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Early-onset_colorectal_cancer_(EOCC)" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Early-onset_colorectal_cancer_(EOCC)"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>Early-onset colorectal cancer (EOCC)</span> </div> </a> <button aria-controls="toc-Early-onset_colorectal_cancer_(EOCC)-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Early-onset colorectal cancer (EOCC) subsection</span> </button> <ul id="toc-Early-onset_colorectal_cancer_(EOCC)-sublist" class="vector-toc-list"> <li id="toc-Incidence_by_age" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Incidence_by_age"> <div class="vector-toc-text"> <span class="vector-toc-numb">9.1</span> <span>Incidence by age</span> </div> </a> <ul id="toc-Incidence_by_age-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Risk_factors" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Risk_factors"> <div class="vector-toc-text"> <span class="vector-toc-numb">9.2</span> <span>Risk factors</span> </div> </a> <ul id="toc-Risk_factors-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Preventative_screening" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Preventative_screening"> <div class="vector-toc-text"> <span class="vector-toc-numb">9.3</span> <span>Preventative screening</span> </div> </a> <ul id="toc-Preventative_screening-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>History</span> </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Society_and_culture" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Society_and_culture"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>Society and culture</span> </div> </a> <ul id="toc-Society_and_culture-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Research" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Research"> <div class="vector-toc-text"> <span class="vector-toc-numb">12</span> <span>Research</span> </div> </a> <ul id="toc-Research-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">13</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">14</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-External_links" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#External_links"> <div class="vector-toc-text"> <span class="vector-toc-numb">15</span> <span>External links</span> </div> </a> <ul id="toc-External_links-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet mw-ui-icon-wikimedia-listBullet"></span> <span class="vector-dropdown-label-text">Toggle the table of contents</span> </label> <div class="vector-dropdown-content"> <div id="vector-page-titlebar-toc-unpinned-container" class="vector-unpinned-container"> </div> </div> </div> </nav> <h1 id="firstHeading" class="firstHeading mw-first-heading"><span class="mw-page-title-main">Colorectal cancer</span></h1> <div id="p-lang-btn" class="vector-dropdown mw-portlet mw-portlet-lang" > <input type="checkbox" id="p-lang-btn-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-p-lang-btn" class="vector-dropdown-checkbox mw-interlanguage-selector" aria-label="Go to an article in another language. Available in 71 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-71" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">71 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-af mw-list-item"><a href="https://af.wikipedia.org/wiki/Kolorektale_kanker" title="Kolorektale kanker – Afrikaans" lang="af" hreflang="af" data-title="Kolorektale kanker" data-language-autonym="Afrikaans" data-language-local-name="Afrikaans" class="interlanguage-link-target"><span>Afrikaans</span></a></li><li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D8%B3%D8%B1%D8%B7%D8%A7%D9%86_%D8%A7%D9%84%D9%82%D9%88%D9%84%D9%88%D9%86" title="سرطان القولون – Arabic" lang="ar" hreflang="ar" data-title="سرطان القولون" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-ast mw-list-item"><a href="https://ast.wikipedia.org/wiki/C%C3%A1ncanu_colorrectal" title="Cáncanu colorrectal – Asturian" lang="ast" hreflang="ast" data-title="Cáncanu colorrectal" data-language-autonym="Asturianu" data-language-local-name="Asturian" class="interlanguage-link-target"><span>Asturianu</span></a></li><li class="interlanguage-link interwiki-az mw-list-item"><a href="https://az.wikipedia.org/wiki/Kolorektal_x%C9%99r%C3%A7%C9%99ng" title="Kolorektal xərçəng – Azerbaijani" lang="az" hreflang="az" data-title="Kolorektal xərçəng" data-language-autonym="Azərbaycanca" data-language-local-name="Azerbaijani" class="interlanguage-link-target"><span>Azərbaycanca</span></a></li><li class="interlanguage-link interwiki-azb mw-list-item"><a href="https://azb.wikipedia.org/wiki/%DB%8C%D9%88%D8%BA%D9%88%D9%86_%D8%A8%D8%A7%D8%BA%DB%8C%D8%B1%D8%B3%D8%A7%D9%82_%D8%B3%D8%B1%D8%B7%D8%A7%D9%86%DB%8C" title="یوغون باغیرساق سرطانی – South Azerbaijani" lang="azb" hreflang="azb" data-title="یوغون باغیرساق سرطانی" data-language-autonym="تۆرکجه" data-language-local-name="South Azerbaijani" class="interlanguage-link-target"><span>تۆرکجه</span></a></li><li class="interlanguage-link interwiki-bn mw-list-item"><a href="https://bn.wikipedia.org/wiki/%E0%A6%AE%E0%A6%B2%E0%A6%BE%E0%A6%B6%E0%A6%AF%E0%A6%BC%E0%A7%87%E0%A6%B0_%E0%A6%95%E0%A7%8D%E0%A6%AF%E0%A6%BE%E0%A6%A8%E0%A7%8D%E0%A6%B8%E0%A6%BE%E0%A6%B0" title="মলাশয়ের ক্যান্সার – Bangla" lang="bn" hreflang="bn" data-title="মলাশয়ের ক্যান্সার" data-language-autonym="বাংলা" data-language-local-name="Bangla" class="interlanguage-link-target"><span>বাংলা</span></a></li><li class="interlanguage-link interwiki-zh-min-nan mw-list-item"><a href="https://zh-min-nan.wikipedia.org/wiki/T%C5%8Da-tn%CC%82g-g%C3%A2m" title="Tōa-tn̂g-gâm – Minnan" lang="nan" hreflang="nan" data-title="Tōa-tn̂g-gâm" data-language-autonym="閩南語 / Bân-lâm-gú" data-language-local-name="Minnan" class="interlanguage-link-target"><span>閩南語 / Bân-lâm-gú</span></a></li><li class="interlanguage-link interwiki-be mw-list-item"><a href="https://be.wikipedia.org/wiki/%D0%A0%D0%B0%D0%BA_%D1%82%D0%BE%D1%9E%D1%81%D1%82%D0%B0%D0%B9_%D0%BA%D1%96%D1%88%D0%BA%D1%96" title="Рак тоўстай кішкі – Belarusian" lang="be" hreflang="be" data-title="Рак тоўстай кішкі" data-language-autonym="Беларуская" data-language-local-name="Belarusian" class="interlanguage-link-target"><span>Беларуская</span></a></li><li class="interlanguage-link interwiki-be-x-old mw-list-item"><a href="https://be-tarask.wikipedia.org/wiki/%D0%A0%D0%B0%D0%BA_%D1%82%D0%BE%D1%9E%D1%81%D1%82%D0%B0%D0%B9_%D0%BA%D1%96%D1%88%D0%BA%D1%96" title="Рак тоўстай кішкі – Belarusian (Taraškievica orthography)" lang="be-tarask" hreflang="be-tarask" data-title="Рак тоўстай кішкі" data-language-autonym="Беларуская (тарашкевіца)" data-language-local-name="Belarusian (Taraškievica orthography)" class="interlanguage-link-target"><span>Беларуская (тарашкевіца)</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%A0%D0%B0%D0%BA_%D0%BD%D0%B0_%D0%B4%D0%B5%D0%B1%D0%B5%D0%BB%D0%BE%D1%82%D0%BE_%D1%87%D0%B5%D1%80%D0%B2%D0%BE" title="Рак на дебелото черво – Bulgarian" lang="bg" hreflang="bg" data-title="Рак на дебелото черво" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-bs mw-list-item"><a href="https://bs.wikipedia.org/wiki/Rak_debelog_crijeva" title="Rak debelog crijeva – Bosnian" lang="bs" hreflang="bs" data-title="Rak debelog crijeva" data-language-autonym="Bosanski" data-language-local-name="Bosnian" class="interlanguage-link-target"><span>Bosanski</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/C%C3%A0ncer_colorectal" title="Càncer colorectal – Catalan" lang="ca" hreflang="ca" data-title="Càncer colorectal" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Kolorekt%C3%A1ln%C3%AD_karcinom" title="Kolorektální karcinom – Czech" lang="cs" hreflang="cs" data-title="Kolorektální karcinom" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-cy mw-list-item"><a href="https://cy.wikipedia.org/wiki/Canser_colorectaidd" title="Canser colorectaidd – Welsh" lang="cy" hreflang="cy" data-title="Canser colorectaidd" data-language-autonym="Cymraeg" data-language-local-name="Welsh" class="interlanguage-link-target"><span>Cymraeg</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/Tyktarmskr%C3%A6ft" title="Tyktarmskræft – Danish" lang="da" hreflang="da" data-title="Tyktarmskræft" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-de badge-Q17437798 badge-goodarticle mw-list-item" title="good article badge"><a href="https://de.wikipedia.org/wiki/Kolorektales_Karzinom" title="Kolorektales Karzinom – German" lang="de" hreflang="de" data-title="Kolorektales Karzinom" data-language-autonym="Deutsch" data-language-local-name="German" class="interlanguage-link-target"><span>Deutsch</span></a></li><li class="interlanguage-link interwiki-dv mw-list-item"><a href="https://dv.wikipedia.org/wiki/%DE%8E%DE%AE%DE%80%DE%AE%DE%83%DE%AA%DE%8E%DE%AC_%DE%86%DE%AC%DE%82%DE%B0%DE%90%DE%A6%DE%83%DE%AA" title="ގޮހޮރުގެ ކެންސަރު – Divehi" lang="dv" hreflang="dv" data-title="ގޮހޮރުގެ ކެންސަރު" data-language-autonym="ދިވެހިބަސް" data-language-local-name="Divehi" class="interlanguage-link-target"><span>ދިވެހިބަސް</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/J%C3%A4mesoolev%C3%A4hk" title="Jämesoolevähk – Estonian" lang="et" hreflang="et" data-title="Jämesoolevähk" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-el mw-list-item"><a href="https://el.wikipedia.org/wiki/%CE%9A%CE%B1%CF%81%CE%BA%CE%AF%CE%BD%CE%BF%CF%82_%CF%84%CE%BF%CF%85_%CF%80%CE%B1%CF%87%CE%AD%CE%BF%CF%82_%CE%B5%CE%BD%CF%84%CE%AD%CF%81%CE%BF%CF%85" title="Καρκίνος του παχέος εντέρου – Greek" lang="el" hreflang="el" data-title="Καρκίνος του παχέος εντέρου" data-language-autonym="Ελληνικά" data-language-local-name="Greek" class="interlanguage-link-target"><span>Ελληνικά</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/C%C3%A1ncer_colorrectal" title="Cáncer colorrectal – Spanish" lang="es" hreflang="es" data-title="Cáncer colorrectal" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-eo mw-list-item"><a href="https://eo.wikipedia.org/wiki/Kojlorektuma_kancero" title="Kojlorektuma kancero – Esperanto" lang="eo" hreflang="eo" data-title="Kojlorektuma kancero" data-language-autonym="Esperanto" data-language-local-name="Esperanto" class="interlanguage-link-target"><span>Esperanto</span></a></li><li class="interlanguage-link interwiki-eu mw-list-item"><a href="https://eu.wikipedia.org/wiki/Kolon_eta_ondesteko_minbizi" title="Kolon eta ondesteko minbizi – Basque" lang="eu" hreflang="eu" data-title="Kolon eta ondesteko minbizi" data-language-autonym="Euskara" data-language-local-name="Basque" class="interlanguage-link-target"><span>Euskara</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%B3%D8%B1%D8%B7%D8%A7%D9%86_%D8%B1%D9%88%D8%AF%D9%87_%D8%A8%D8%B2%D8%B1%DA%AF" title="سرطان روده بزرگ – Persian" lang="fa" hreflang="fa" data-title="سرطان روده بزرگ" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Cancer_colorectal" title="Cancer colorectal – French" lang="fr" hreflang="fr" data-title="Cancer colorectal" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/Cancro_colorrectal" title="Cancro colorrectal – Galician" lang="gl" hreflang="gl" data-title="Cancro colorrectal" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target"><span>Galego</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%8C%80%EC%9E%A5%EC%95%94" title="대장암 – Korean" lang="ko" hreflang="ko" data-title="대장암" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-ha mw-list-item"><a href="https://ha.wikipedia.org/wiki/Ciwon_daji_mai_launi" title="Ciwon daji mai launi – Hausa" lang="ha" hreflang="ha" data-title="Ciwon daji mai launi" data-language-autonym="Hausa" data-language-local-name="Hausa" class="interlanguage-link-target"><span>Hausa</span></a></li><li class="interlanguage-link interwiki-hy mw-list-item"><a href="https://hy.wikipedia.org/wiki/%D4%BF%D5%B8%D5%AC%D5%B8%D5%BC%D5%A5%D5%AF%D5%BF%D5%A1%D5%AC_%D6%84%D5%A1%D5%B2%D6%81%D5%AF%D5%A5%D5%B2" title="Կոլոռեկտալ քաղցկեղ – Armenian" lang="hy" hreflang="hy" data-title="Կոլոռեկտալ քաղցկեղ" data-language-autonym="Հայերեն" data-language-local-name="Armenian" class="interlanguage-link-target"><span>Հայերեն</span></a></li><li class="interlanguage-link interwiki-hi mw-list-item"><a href="https://hi.wikipedia.org/wiki/%E0%A4%AC%E0%A5%83%E0%A4%B9%E0%A4%A6%E0%A4%BE%E0%A4%82%E0%A4%A4%E0%A5%8D%E0%A4%B0_%E0%A4%95%E0%A5%88%E0%A4%A8%E0%A5%8D%E0%A4%B8%E0%A4%B0" title="बृहदांत्र कैन्सर – Hindi" lang="hi" hreflang="hi" data-title="बृहदांत्र कैन्सर" data-language-autonym="हिन्दी" data-language-local-name="Hindi" class="interlanguage-link-target"><span>हिन्दी</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/Rak_debelog_crijeva" title="Rak debelog crijeva – Croatian" lang="hr" hreflang="hr" data-title="Rak debelog crijeva" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Kanker_usus_besar" title="Kanker usus besar – Indonesian" lang="id" hreflang="id" data-title="Kanker usus besar" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Carcinoma_del_colon-retto" title="Carcinoma del colon-retto – Italian" lang="it" hreflang="it" data-title="Carcinoma del colon-retto" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/%D7%A1%D7%A8%D7%98%D7%9F_%D7%94%D7%9E%D7%A2%D7%99_%D7%94%D7%92%D7%A1" title="סרטן המעי הגס – Hebrew" lang="he" hreflang="he" data-title="סרטן המעי הגס" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Cancer_colorectalis" title="Cancer colorectalis – Latin" lang="la" hreflang="la" data-title="Cancer colorectalis" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target"><span>Latina</span></a></li><li class="interlanguage-link interwiki-lv mw-list-item"><a href="https://lv.wikipedia.org/wiki/Zarnu_v%C4%93zis" title="Zarnu vēzis – Latvian" lang="lv" hreflang="lv" data-title="Zarnu vēzis" data-language-autonym="Latviešu" data-language-local-name="Latvian" class="interlanguage-link-target"><span>Latviešu</span></a></li><li class="interlanguage-link interwiki-lt mw-list-item"><a href="https://lt.wikipedia.org/wiki/Storosios_%C5%BEarnos_v%C4%97%C5%BEys" title="Storosios žarnos vėžys – Lithuanian" lang="lt" hreflang="lt" data-title="Storosios žarnos vėžys" data-language-autonym="Lietuvių" data-language-local-name="Lithuanian" class="interlanguage-link-target"><span>Lietuvių</span></a></li><li class="interlanguage-link interwiki-hu mw-list-item"><a href="https://hu.wikipedia.org/wiki/Vastagb%C3%A9lr%C3%A1k" title="Vastagbélrák – Hungarian" lang="hu" hreflang="hu" data-title="Vastagbélrák" data-language-autonym="Magyar" data-language-local-name="Hungarian" class="interlanguage-link-target"><span>Magyar</span></a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%A0%D0%B0%D0%BA_%D0%BD%D0%B0_%D0%B4%D0%B5%D0%B1%D0%B5%D0%BB%D0%BE%D1%82%D0%BE_%D1%86%D1%80%D0%B5%D0%B2%D0%BE" title="Рак на дебелото црево – Macedonian" lang="mk" hreflang="mk" data-title="Рак на дебелото црево" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target"><span>Македонски</span></a></li><li class="interlanguage-link interwiki-mr mw-list-item"><a href="https://mr.wikipedia.org/wiki/%E0%A4%AE%E0%A5%8B%E0%A4%A0%E0%A5%8D%E0%A4%AF%E0%A4%BE_%E0%A4%86%E0%A4%A4%E0%A4%A1%E0%A5%8D%E0%A4%AF%E0%A4%BE%E0%A4%9A%E0%A4%BE_%E0%A4%95%E0%A4%B0%E0%A5%8D%E0%A4%95%E0%A4%B0%E0%A5%8B%E0%A4%97" title="मोठ्या आतड्याचा कर्करोग – Marathi" lang="mr" hreflang="mr" data-title="मोठ्या आतड्याचा कर्करोग" data-language-autonym="मराठी" data-language-local-name="Marathi" class="interlanguage-link-target"><span>मराठी</span></a></li><li class="interlanguage-link interwiki-arz mw-list-item"><a href="https://arz.wikipedia.org/wiki/%D8%B3%D8%B1%D8%B7%D8%A7%D9%86_%D8%A7%D9%84%D9%82%D9%88%D9%84%D9%88%D9%86" title="سرطان القولون – Egyptian Arabic" lang="arz" hreflang="arz" data-title="سرطان القولون" data-language-autonym="مصرى" data-language-local-name="Egyptian Arabic" class="interlanguage-link-target"><span>مصرى</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Barah_usus" title="Barah usus – Malay" lang="ms" hreflang="ms" data-title="Barah usus" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Darmkanker" title="Darmkanker – Dutch" lang="nl" hreflang="nl" data-title="Darmkanker" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ne mw-list-item"><a href="https://ne.wikipedia.org/wiki/%E0%A4%95%E0%A5%8B%E0%A4%B2%E0%A5%8B%E0%A4%B0%E0%A5%87%E0%A4%95%E0%A5%8D%E0%A4%9F%E0%A4%B0_%E0%A4%95%E0%A5%8D%E0%A4%AF%E0%A4%BE%E0%A4%A8%E0%A5%8D%E0%A4%B8%E0%A4%B0" title="कोलोरेक्टर क्यान्सर – Nepali" lang="ne" hreflang="ne" data-title="कोलोरेक्टर क्यान्सर" data-language-autonym="नेपाली" data-language-local-name="Nepali" class="interlanguage-link-target"><span>नेपाली</span></a></li><li class="interlanguage-link interwiki-new mw-list-item"><a href="https://new.wikipedia.org/wiki/%E0%A4%95%E0%A5%8B%E0%A4%B2%E0%A5%8B%E0%A4%B0%E0%A5%87%E0%A4%95%E0%A5%8D%E0%A4%9F%E0%A4%B2_%E0%A4%95%E0%A5%8D%E0%A4%AF%E0%A4%BE%E0%A4%A8%E0%A5%8D%E0%A4%B8%E0%A4%B0" title="कोलोरेक्टल क्यान्सर – Newari" lang="new" hreflang="new" data-title="कोलोरेक्टल क्यान्सर" data-language-autonym="नेपाल भाषा" data-language-local-name="Newari" class="interlanguage-link-target"><span>नेपाल भाषा</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E5%A4%A7%E8%85%B8%E7%99%8C" title="大腸癌 – Japanese" lang="ja" hreflang="ja" data-title="大腸癌" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Tarmkreft" title="Tarmkreft – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Tarmkreft" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-or mw-list-item"><a href="https://or.wikipedia.org/wiki/%E0%AC%AC%E0%AD%83%E0%AC%B9%E0%AC%A6%E0%AC%A8%E0%AD%8D%E0%AC%A4%E0%AD%8D%E0%AC%B0-%E0%AC%AE%E0%AC%B3%E0%AC%BE%E0%AC%B6%E0%AD%9F_%E0%AC%95%E0%AC%B0%E0%AD%8D%E0%AC%95%E0%AC%9F" title="ବୃହଦନ୍ତ୍ର-ମଳାଶୟ କର୍କଟ – Odia" lang="or" hreflang="or" data-title="ବୃହଦନ୍ତ୍ର-ମଳାଶୟ କର୍କଟ" data-language-autonym="ଓଡ଼ିଆ" data-language-local-name="Odia" class="interlanguage-link-target"><span>ଓଡ଼ିଆ</span></a></li><li class="interlanguage-link interwiki-pa mw-list-item"><a href="https://pa.wikipedia.org/wiki/%E0%A8%95%E0%A9%8B%E0%A8%B2%E0%A8%A8_%E0%A8%95%E0%A9%88%E0%A8%82%E0%A8%B8%E0%A8%B0" title="ਕੋਲਨ ਕੈਂਸਰ – Punjabi" lang="pa" hreflang="pa" data-title="ਕੋਲਨ ਕੈਂਸਰ" data-language-autonym="ਪੰਜਾਬੀ" data-language-local-name="Punjabi" class="interlanguage-link-target"><span>ਪੰਜਾਬੀ</span></a></li><li class="interlanguage-link interwiki-pl badge-Q17437796 badge-featuredarticle mw-list-item" title="featured article badge"><a href="https://pl.wikipedia.org/wiki/Rak_jelita_grubego" title="Rak jelita grubego – Polish" lang="pl" hreflang="pl" data-title="Rak jelita grubego" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/C%C3%A2ncer_colorretal" title="Câncer colorretal – Portuguese" lang="pt" hreflang="pt" data-title="Câncer colorretal" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Cancer_de_colon" title="Cancer de colon – Romanian" lang="ro" hreflang="ro" data-title="Cancer de colon" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target"><span>Română</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BB%D0%BE%D1%80%D0%B5%D0%BA%D1%82%D0%B0%D0%BB%D1%8C%D0%BD%D1%8B%D0%B9_%D1%80%D0%B0%D0%BA" title="Колоректальный рак – Russian" lang="ru" hreflang="ru" data-title="Колоректальный рак" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-sq mw-list-item"><a href="https://sq.wikipedia.org/wiki/Kanceri_kolorektal" title="Kanceri kolorektal – Albanian" lang="sq" hreflang="sq" data-title="Kanceri kolorektal" data-language-autonym="Shqip" data-language-local-name="Albanian" class="interlanguage-link-target"><span>Shqip</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/Colorectal_cancer" title="Colorectal cancer – Simple English" lang="en-simple" hreflang="en-simple" data-title="Colorectal cancer" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sk mw-list-item"><a href="https://sk.wikipedia.org/wiki/Kolorekt%C3%A1lny_karcin%C3%B3m" title="Kolorektálny karcinóm – Slovak" lang="sk" hreflang="sk" data-title="Kolorektálny karcinóm" data-language-autonym="Slovenčina" data-language-local-name="Slovak" class="interlanguage-link-target"><span>Slovenčina</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Rak_debelega_%C4%8Drevesa_in_danke" title="Rak debelega črevesa in danke – Slovenian" lang="sl" hreflang="sl" data-title="Rak debelega črevesa in danke" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/Rak_debelog_creva" title="Rak debelog creva – Serbian" lang="sr" hreflang="sr" data-title="Rak debelog creva" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Rak_debelog_crijeva" title="Rak debelog crijeva – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Rak debelog crijeva" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/Paksusuolen_sy%C3%B6p%C3%A4" title="Paksusuolen syöpä – Finnish" lang="fi" hreflang="fi" data-title="Paksusuolen syöpä" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/Kolorektalcancer" title="Kolorektalcancer – Swedish" lang="sv" hreflang="sv" data-title="Kolorektalcancer" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-ta mw-list-item"><a href="https://ta.wikipedia.org/wiki/%E0%AE%AA%E0%AF%86%E0%AE%B0%E0%AF%81%E0%AE%99%E0%AF%8D%E0%AE%95%E0%AF%81%E0%AE%9F%E0%AE%B2%E0%AF%8D_%E0%AE%AE%E0%AE%B2%E0%AE%95%E0%AF%81%E0%AE%9F%E0%AE%B2%E0%AF%81%E0%AE%95%E0%AF%8D%E0%AE%95%E0%AF%81%E0%AE%B0%E0%AE%BF%E0%AE%AF_%E0%AE%AA%E0%AF%81%E0%AE%B1%E0%AF%8D%E0%AE%B1%E0%AF%81_%E0%AE%A8%E0%AF%8B%E0%AE%AF%E0%AF%8D" title="பெருங்குடல் மலகுடலுக்குரிய புற்று நோய் – Tamil" lang="ta" hreflang="ta" data-title="பெருங்குடல் மலகுடலுக்குரிய புற்று நோய்" data-language-autonym="தமிழ்" data-language-local-name="Tamil" class="interlanguage-link-target"><span>தமிழ்</span></a></li><li class="interlanguage-link interwiki-te mw-list-item"><a href="https://te.wikipedia.org/wiki/%E0%B0%95%E0%B1%8A%E0%B0%B2%E0%B1%8B%E0%B0%B0%E0%B1%86%E0%B0%95%E0%B1%8D%E0%B0%9F%E0%B0%B2%E0%B1%8D_%E0%B0%95%E0%B1%8D%E0%B0%AF%E0%B0%BE%E0%B0%A8%E0%B1%8D%E0%B0%B8%E0%B0%B0%E0%B1%8D" title="కొలోరెక్టల్ క్యాన్సర్ – Telugu" lang="te" hreflang="te" data-title="కొలోరెక్టల్ క్యాన్సర్" data-language-autonym="తెలుగు" data-language-local-name="Telugu" class="interlanguage-link-target"><span>తెలుగు</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/%E0%B8%A1%E0%B8%B0%E0%B9%80%E0%B8%A3%E0%B9%87%E0%B8%87%E0%B8%A5%E0%B8%B3%E0%B9%84%E0%B8%AA%E0%B9%89%E0%B9%83%E0%B8%AB%E0%B8%8D%E0%B9%88" title="มะเร็งลำไส้ใหญ่ – Thai" lang="th" hreflang="th" data-title="มะเร็งลำไส้ใหญ่" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-tr mw-list-item"><a href="https://tr.wikipedia.org/wiki/Kal%C4%B1n_ba%C4%9F%C4%B1rsak_kanseri" title="Kalın bağırsak kanseri – Turkish" lang="tr" hreflang="tr" data-title="Kalın bağırsak kanseri" data-language-autonym="Türkçe" data-language-local-name="Turkish" class="interlanguage-link-target"><span>Türkçe</span></a></li><li class="interlanguage-link interwiki-uk mw-list-item"><a href="https://uk.wikipedia.org/wiki/%D0%9A%D0%BE%D0%BB%D0%BE%D1%80%D0%B5%D0%BA%D1%82%D0%B0%D0%BB%D1%8C%D0%BD%D0%B8%D0%B9_%D1%80%D0%B0%D0%BA" title="Колоректальний рак – Ukrainian" lang="uk" hreflang="uk" data-title="Колоректальний рак" data-language-autonym="Українська" data-language-local-name="Ukrainian" class="interlanguage-link-target"><span>Українська</span></a></li><li class="interlanguage-link interwiki-ur mw-list-item"><a href="https://ur.wikipedia.org/wiki/%D9%82%D9%88%D9%84%D9%88%D9%86%DB%8C_%D8%B3%D8%B1%D8%B7%D8%A7%D9%86" title="قولونی سرطان – Urdu" lang="ur" hreflang="ur" data-title="قولونی سرطان" data-language-autonym="اردو" data-language-local-name="Urdu" class="interlanguage-link-target"><span>اردو</span></a></li><li class="interlanguage-link interwiki-vi mw-list-item"><a href="https://vi.wikipedia.org/wiki/Ung_th%C6%B0_%C4%91%E1%BA%A1i_tr%E1%BB%B1c_tr%C3%A0ng" title="Ung thư đại trực tràng – Vietnamese" lang="vi" hreflang="vi" data-title="Ung thư đại trực tràng" data-language-autonym="Tiếng Việt" data-language-local-name="Vietnamese" class="interlanguage-link-target"><span>Tiếng Việt</span></a></li><li class="interlanguage-link interwiki-wuu mw-list-item"><a href="https://wuu.wikipedia.org/wiki/%E7%BB%93%E7%9B%B4%E8%82%A0%E7%99%8C" title="结直肠癌 – Wu" lang="wuu" hreflang="wuu" data-title="结直肠癌" data-language-autonym="吴语" data-language-local-name="Wu" class="interlanguage-link-target"><span>吴语</span></a></li><li class="interlanguage-link interwiki-yi mw-list-item"><a href="https://yi.wikipedia.org/wiki/%D7%A7%D7%99%D7%A9%D7%A7%D7%A2_%D7%A7%D7%A2%D7%A0%D7%A1%D7%A2%D7%A8" title="קישקע קענסער – Yiddish" lang="yi" hreflang="yi" data-title="קישקע קענסער" data-language-autonym="ייִדיש" data-language-local-name="Yiddish" class="interlanguage-link-target"><span>ייִדיש</span></a></li><li class="interlanguage-link interwiki-zh-yue mw-list-item"><a href="https://zh-yue.wikipedia.org/wiki/%E7%B5%90%E8%85%B8%E7%99%8C" title="結腸癌 – Cantonese" lang="yue" hreflang="yue" data-title="結腸癌" data-language-autonym="粵語" data-language-local-name="Cantonese" class="interlanguage-link-target"><span>粵語</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E5%A4%A7%E8%85%B8%E7%99%8C" title="大腸癌 – Chinese" lang="zh" hreflang="zh" data-title="大腸癌" data-language-autonym="中文" data-language-local-name="Chinese" class="interlanguage-link-target"><span>中文</span></a></li> </ul> <div class="after-portlet after-portlet-lang"><span class="wb-langlinks-edit wb-langlinks-link"><a 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id="mw-content-text" class="mw-body-content"><div class="mw-content-ltr mw-parser-output" lang="en" dir="ltr"><div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Cancer of the colon or rectum</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">For cancer of the anus, see <a href="/wiki/Anal_cancer" title="Anal cancer">Anal cancer</a>.</div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">"Intestinal cancer" redirects here. For cancer of the small intestine, see <a href="/wiki/Small_intestine_cancer" title="Small intestine cancer">Small intestine cancer</a>.</div> <p class="mw-empty-elt"> </p> <div class="shortdescription nomobile noexcerpt noprint searchaux" style="display:none">Medical condition</div><style data-mw-deduplicate="TemplateStyles:r1257001546">.mw-parser-output .infobox-subbox{padding:0;border:none;margin:-3px;width:auto;min-width:100%;font-size:100%;clear:none;float:none;background-color:transparent}.mw-parser-output .infobox-3cols-child{margin:auto}.mw-parser-output .infobox .navbar{font-size:100%}@media screen{html.skin-theme-clientpref-night .mw-parser-output .infobox-full-data:not(.notheme)>div:not(.notheme)[style]{background:#1f1f23!important;color:#f8f9fa}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .infobox-full-data:not(.notheme) div:not(.notheme){background:#1f1f23!important;color:#f8f9fa}}@media(min-width:640px){body.skin--responsive .mw-parser-output .infobox-table{display:table!important}body.skin--responsive .mw-parser-output .infobox-table>caption{display:table-caption!important}body.skin--responsive .mw-parser-output .infobox-table>tbody{display:table-row-group}body.skin--responsive .mw-parser-output .infobox-table tr{display:table-row!important}body.skin--responsive .mw-parser-output .infobox-table th,body.skin--responsive .mw-parser-output .infobox-table td{padding-left:inherit;padding-right:inherit}}</style><table class="infobox ib-medical-condition"><tbody><tr><th colspan="2" class="infobox-above" style="background:#ccc">Colorectal cancer</th></tr><tr><th scope="row" class="infobox-label">Other names</th><td class="infobox-data"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline ol,.mw-parser-output .hlist.inline ul,.mw-parser-output .hlist dl dl,.mw-parser-output .hlist dl ol,.mw-parser-output .hlist dl ul,.mw-parser-output .hlist ol dl,.mw-parser-output .hlist ol ol,.mw-parser-output .hlist ol ul,.mw-parser-output .hlist ul dl,.mw-parser-output .hlist ul ol,.mw-parser-output .hlist ul ul{display:inline}.mw-parser-output .hlist .mw-empty-li{display:none}.mw-parser-output .hlist dt::after{content:": "}.mw-parser-output .hlist dd::after,.mw-parser-output .hlist li::after{content:" · ";font-weight:bold}.mw-parser-output .hlist dd:last-child::after,.mw-parser-output .hlist dt:last-child::after,.mw-parser-output .hlist li:last-child::after{content:none}.mw-parser-output .hlist dd dd:first-child::before,.mw-parser-output .hlist dd dt:first-child::before,.mw-parser-output .hlist dd li:first-child::before,.mw-parser-output .hlist dt dd:first-child::before,.mw-parser-output .hlist dt dt:first-child::before,.mw-parser-output .hlist dt li:first-child::before,.mw-parser-output .hlist li dd:first-child::before,.mw-parser-output .hlist li dt:first-child::before,.mw-parser-output .hlist li li:first-child::before{content:" (";font-weight:normal}.mw-parser-output .hlist dd dd:last-child::after,.mw-parser-output .hlist dd dt:last-child::after,.mw-parser-output .hlist dd li:last-child::after,.mw-parser-output .hlist dt dd:last-child::after,.mw-parser-output .hlist dt dt:last-child::after,.mw-parser-output .hlist dt li:last-child::after,.mw-parser-output .hlist li dd:last-child::after,.mw-parser-output .hlist li dt:last-child::after,.mw-parser-output .hlist li li:last-child::after{content:")";font-weight:normal}.mw-parser-output .hlist ol{counter-reset:listitem}.mw-parser-output .hlist ol>li{counter-increment:listitem}.mw-parser-output .hlist ol>li::before{content:" "counter(listitem)"\a0 "}.mw-parser-output .hlist dd ol>li:first-child::before,.mw-parser-output .hlist dt ol>li:first-child::before,.mw-parser-output .hlist li ol>li:first-child::before{content:" ("counter(listitem)"\a0 "}</style><div class="hlist"><ul><li>Colon cancer</li><li>rectal cancer</li><li>bowel cancer</li></ul></div></td></tr><tr style="background-color: #f8f9fa;"><td colspan="2" class="infobox-full-data"><span class="mw-default-size" typeof="mw:File/Frameless"><a href="/wiki/File:Blausen_0246_ColorectalCancer.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/1/12/Blausen_0246_ColorectalCancer.png/220px-Blausen_0246_ColorectalCancer.png" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/12/Blausen_0246_ColorectalCancer.png/330px-Blausen_0246_ColorectalCancer.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/12/Blausen_0246_ColorectalCancer.png/440px-Blausen_0246_ColorectalCancer.png 2x" data-file-width="1024" data-file-height="768" /></a></span></td></tr><tr><td colspan="2" class="infobox-full-data">Location and appearance of two example colorectal tumors</td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_specialty" title="Medical specialty">Specialty</a></th><td class="infobox-data"><a href="/wiki/Gastroenterology" title="Gastroenterology">Gastroenterology</a> <a href="/wiki/General_surgery" title="General surgery">General surgery</a> <a href="/wiki/Oncology" title="Oncology">Oncology</a></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Signs_and_symptoms" title="Signs and symptoms">Symptoms</a></th><td class="infobox-data"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><div class="hlist"><ul><li><a href="/wiki/Blood_in_stool" title="Blood in stool">Blood in stool</a></li><li>change in bowel movements</li><li>unintentional <a href="/wiki/Weight_loss" title="Weight loss">weight loss</a></li><li><a href="/wiki/Vomiting" title="Vomiting">vomiting</a></li><li>fatigue<sup id="cite_ref-NCI2014Pt_1-0" class="reference"><a href="#cite_note-NCI2014Pt-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></li></ul></div></td></tr><tr><th scope="row" class="infobox-label">Causes</th><td class="infobox-data">Lifestyle factors and genetic disorders<sup id="cite_ref-WCR2014_5.5_2-0" class="reference"><a href="#cite_note-WCR2014_5.5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-NCI2014Pre_3-0" class="reference"><a href="#cite_note-NCI2014Pre-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Risk_factor" title="Risk factor">Risk factors</a></th><td class="infobox-data"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><div class="hlist"><ul><li>Diet</li><li><a href="/wiki/Obesity" title="Obesity">obesity</a></li><li>smoking</li><li>lack of <a href="/wiki/Physical_activity" title="Physical activity">physical activity</a></li><li><a href="/wiki/Alcohol_and_cancer" title="Alcohol and cancer">alcohol use</a><sup id="cite_ref-WCR2014_5.5_2-1" class="reference"><a href="#cite_note-WCR2014_5.5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Theodoratou2017_4-0" class="reference"><a href="#cite_note-Theodoratou2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup></li></ul></div></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Medical_diagnosis" title="Medical diagnosis">Diagnostic method</a></th><td class="infobox-data"><a href="/wiki/Tissue_biopsy" class="mw-redirect" title="Tissue biopsy">Tissue biopsy</a> during a <a href="/wiki/Sigmoidoscopy" title="Sigmoidoscopy">sigmoidoscopy</a> or <a href="/wiki/Colonoscopy" title="Colonoscopy">colonoscopy</a><sup id="cite_ref-NCI2014Pt_1-1" class="reference"><a href="#cite_note-NCI2014Pt-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Prevention</th><td class="infobox-data"><a href="/wiki/Cancer_screening" title="Cancer screening">Screening</a> from age of 45 to 75</td></tr><tr><th scope="row" class="infobox-label">Treatment</th><td class="infobox-data"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><div class="hlist"><ul><li><a href="/wiki/Surgery" title="Surgery">Surgery</a></li><li><a href="/wiki/Radiation_therapy" title="Radiation therapy">radiation therapy</a></li><li><a href="/wiki/Chemotherapy" title="Chemotherapy">chemotherapy</a></li><li><a href="/wiki/Targeted_therapy" title="Targeted therapy">targeted therapy</a><sup id="cite_ref-NCI2014PtTx_5-0" class="reference"><a href="#cite_note-NCI2014PtTx-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup></li></ul></div></td></tr><tr><th scope="row" class="infobox-label"><a href="/wiki/Prognosis" title="Prognosis">Prognosis</a></th><td class="infobox-data"><a href="/wiki/Five-year_survival_rate" title="Five-year survival rate">Five-year survival rate</a> 65% (US)<sup id="cite_ref-SEER2014_6-0" class="reference"><a href="#cite_note-SEER2014-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Frequency</th><td class="infobox-data">9.4 million (2015)<sup id="cite_ref-GBD2015Pre_7-0" class="reference"><a href="#cite_note-GBD2015Pre-7"><span class="cite-bracket">[</span>7<span class="cite-bracket">]</span></a></sup></td></tr><tr><th scope="row" class="infobox-label">Deaths</th><td class="infobox-data">551,000 (2018)<sup id="cite_ref-Bray2018_8-0" class="reference"><a href="#cite_note-Bray2018-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup></td></tr></tbody></table> <p><b>Colorectal cancer</b> (<b>CRC</b>), also known as <b>bowel cancer</b>, <b>colon cancer</b>, or <b>rectal cancer</b>, is the development of <a href="/wiki/Cancer" title="Cancer">cancer</a> from the <a href="/wiki/Colon_(anatomy)" class="mw-redirect" title="Colon (anatomy)">colon</a> or <a href="/wiki/Rectum" title="Rectum">rectum</a> (parts of the <a href="/wiki/Large_intestine" title="Large intestine">large intestine</a>).<sup id="cite_ref-NCI2014PtTx_5-1" class="reference"><a href="#cite_note-NCI2014PtTx-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Signs and symptoms may include <a href="/wiki/Lower_gastrointestinal_bleeding" title="Lower gastrointestinal bleeding">blood in the stool</a>, a change in <a href="/wiki/Bowel_movements" class="mw-redirect" title="Bowel movements">bowel movements</a>, weight loss, abdominal pain and fatigue.<sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">[</span>9<span class="cite-bracket">]</span></a></sup> Most colorectal cancers are due to lifestyle factors and genetic disorders.<sup id="cite_ref-WCR2014_5.5_2-2" class="reference"><a href="#cite_note-WCR2014_5.5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-NCI2014Pre_3-1" class="reference"><a href="#cite_note-NCI2014Pre-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> Risk factors include diet, <a href="/wiki/Obesity" title="Obesity">obesity</a>, smoking, and lack of <a href="/wiki/Physical_activity" title="Physical activity">physical activity</a>.<sup id="cite_ref-WCR2014_5.5_2-3" class="reference"><a href="#cite_note-WCR2014_5.5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Dietary factors that increase the risk include <a href="/wiki/Red_meat" title="Red meat">red meat</a>, <a href="/wiki/Processed_meat" title="Processed meat">processed meat</a>, and <a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">alcohol</a>.<sup id="cite_ref-WCR2014_5.5_2-4" class="reference"><a href="#cite_note-WCR2014_5.5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Theodoratou2017_4-1" class="reference"><a href="#cite_note-Theodoratou2017-4"><span class="cite-bracket">[</span>4<span class="cite-bracket">]</span></a></sup> Another risk factor is <a href="/wiki/Inflammatory_bowel_disease" title="Inflammatory bowel disease">inflammatory bowel disease</a>, which includes <a href="/wiki/Crohn%27s_disease" title="Crohn's disease">Crohn's disease</a> and <a href="/wiki/Ulcerative_colitis" title="Ulcerative colitis">ulcerative colitis</a>.<sup id="cite_ref-WCR2014_5.5_2-5" class="reference"><a href="#cite_note-WCR2014_5.5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> Some of the inherited genetic disorders that can cause colorectal cancer include <a href="/wiki/Familial_adenomatous_polyposis" title="Familial adenomatous polyposis">familial adenomatous polyposis</a> and <a href="/wiki/Hereditary_non-polyposis_colon_cancer" class="mw-redirect" title="Hereditary non-polyposis colon cancer">hereditary non-polyposis colon cancer</a>; however, these represent less than 5% of cases.<sup id="cite_ref-WCR2014_5.5_2-6" class="reference"><a href="#cite_note-WCR2014_5.5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-NCI2014Pre_3-2" class="reference"><a href="#cite_note-NCI2014Pre-3"><span class="cite-bracket">[</span>3<span class="cite-bracket">]</span></a></sup> It typically starts as a <a href="/wiki/Adenoma" title="Adenoma">benign tumor</a>, often in the form of a <a href="/wiki/Colorectal_polyp" title="Colorectal polyp">polyp</a>, which over time becomes <a href="/wiki/Carcinoma" title="Carcinoma">cancerous</a>.<sup id="cite_ref-WCR2014_5.5_2-7" class="reference"><a href="#cite_note-WCR2014_5.5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p><p>Colorectal cancer may be diagnosed by <a href="/wiki/Biopsy" title="Biopsy">obtaining a sample</a> of the colon during a <a href="/wiki/Sigmoidoscopy" title="Sigmoidoscopy">sigmoidoscopy</a> or <a href="/wiki/Colonoscopy" title="Colonoscopy">colonoscopy</a>.<sup id="cite_ref-NCI2014Pt_1-2" class="reference"><a href="#cite_note-NCI2014Pt-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> This is then followed by <a href="/wiki/Medical_imaging" title="Medical imaging">medical imaging</a> to determine whether the disease has spread.<sup id="cite_ref-NCI2014PtTx_5-2" class="reference"><a href="#cite_note-NCI2014PtTx-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Cancer_screening" title="Cancer screening">Screening</a> is effective for preventing and decreasing deaths from colorectal cancer.<sup id="cite_ref-USPSTF2016_10-0" class="reference"><a href="#cite_note-USPSTF2016-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Screening, by one of several methods, is recommended starting from ages 45 to 75. It was recommended starting at age 50 but it was changed to 45 due to increasing numbers of colon cancers.<sup id="cite_ref-USPSTF2016_10-1" class="reference"><a href="#cite_note-USPSTF2016-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-11" class="reference"><a href="#cite_note-11"><span class="cite-bracket">[</span>11<span class="cite-bracket">]</span></a></sup> During colonoscopy, small polyps may be removed if found.<sup id="cite_ref-WCR2014_5.5_2-8" class="reference"><a href="#cite_note-WCR2014_5.5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> If a large polyp or tumor is found, a <a href="/wiki/Biopsy" title="Biopsy">biopsy</a> may be performed to check if it is cancerous. <a href="/wiki/Aspirin" title="Aspirin">Aspirin</a> and other <a href="/wiki/Non-steroidal_anti-inflammatory_drugs" class="mw-redirect" title="Non-steroidal anti-inflammatory drugs">non-steroidal anti-inflammatory drugs</a> decrease the risk of pain during polyp excision.<sup id="cite_ref-WCR2014_5.5_2-9" class="reference"><a href="#cite_note-WCR2014_5.5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-12" class="reference"><a href="#cite_note-12"><span class="cite-bracket">[</span>12<span class="cite-bracket">]</span></a></sup> Their general use is not recommended for this purpose, however, due to side effects.<sup id="cite_ref-13" class="reference"><a href="#cite_note-13"><span class="cite-bracket">[</span>13<span class="cite-bracket">]</span></a></sup> </p><p>Treatments used for colorectal cancer may include some combination of surgery, <a href="/wiki/Radiation_therapy" title="Radiation therapy">radiation therapy</a>, <a href="/wiki/Chemotherapy" title="Chemotherapy">chemotherapy</a>, and <a href="/wiki/Targeted_therapy" title="Targeted therapy">targeted therapy</a>.<sup id="cite_ref-NCI2014PtTx_5-3" class="reference"><a href="#cite_note-NCI2014PtTx-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Cancers that are confined within the wall of the colon may be curable with surgery, while <a href="/wiki/Metastasis" title="Metastasis">cancer that has spread widely</a> is usually not curable, with management being directed towards improving <a href="/wiki/Quality_of_life" title="Quality of life">quality of life</a> and symptoms.<sup id="cite_ref-NCI2014PtTx_5-4" class="reference"><a href="#cite_note-NCI2014PtTx-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/Five-year_survival_rate" title="Five-year survival rate">five-year survival rate</a> in the United States was around 65% in 2014.<sup id="cite_ref-SEER2014_6-1" class="reference"><a href="#cite_note-SEER2014-6"><span class="cite-bracket">[</span>6<span class="cite-bracket">]</span></a></sup> The individual likelihood of survival depends on how advanced the cancer is, whether or not all the cancer can be removed with surgery, and the person's overall health.<sup id="cite_ref-NCI2014Pt_1-3" class="reference"><a href="#cite_note-NCI2014Pt-1"><span class="cite-bracket">[</span>1<span class="cite-bracket">]</span></a></sup> Globally, colorectal cancer is the third most common type of cancer, making up about 10% of all cases.<sup id="cite_ref-WCR2014Epi_14-0" class="reference"><a href="#cite_note-WCR2014Epi-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup> In 2018, there were 1.09 million new cases and 551,000 deaths from the disease.<sup id="cite_ref-Bray2018_8-1" class="reference"><a href="#cite_note-Bray2018-8"><span class="cite-bracket">[</span>8<span class="cite-bracket">]</span></a></sup> It is more common in <a href="/wiki/Developed_country" title="Developed country">developed countries</a>, where more than 65% of cases are found.<sup id="cite_ref-WCR2014_5.5_2-10" class="reference"><a href="#cite_note-WCR2014_5.5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> It is less common in women than men.<sup id="cite_ref-WCR2014_5.5_2-11" class="reference"><a href="#cite_note-WCR2014_5.5-2"><span class="cite-bracket">[</span>2<span class="cite-bracket">]</span></a></sup> </p> <style data-mw-deduplicate="TemplateStyles:r886046785">.mw-parser-output .toclimit-2 .toclevel-1 ul,.mw-parser-output .toclimit-3 .toclevel-2 ul,.mw-parser-output .toclimit-4 .toclevel-3 ul,.mw-parser-output .toclimit-5 .toclevel-4 ul,.mw-parser-output .toclimit-6 .toclevel-5 ul,.mw-parser-output .toclimit-7 .toclevel-6 ul{display:none}</style><div class="toclimit-3"><meta property="mw:PageProp/toc" /></div> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The signs and symptoms of colorectal cancer depend on the location of the <a href="/wiki/Tumor" class="mw-redirect" title="Tumor">tumor</a> in the <a href="/wiki/Bowel" class="mw-redirect" title="Bowel">bowel</a>, and whether it has spread elsewhere in the body (<a href="/wiki/Metastasis" title="Metastasis">metastasis</a>). The classic warning signs include: worsening <a href="/wiki/Constipation" title="Constipation">constipation</a>, blood in the <a href="/wiki/Stool_test" title="Stool test">stool</a>, decrease in stool caliber (thickness), loss of appetite, loss of weight, and <a href="/wiki/Nausea" title="Nausea">nausea</a> or <a href="/wiki/Vomiting" title="Vomiting">vomiting</a> in someone over 50 years old.<sup id="cite_ref-15" class="reference"><a href="#cite_note-15"><span class="cite-bracket">[</span>15<span class="cite-bracket">]</span></a></sup> Around 50% of people who have colorectal cancer do not report any symptoms.<sup id="cite_ref-16" class="reference"><a href="#cite_note-16"><span class="cite-bracket">[</span>16<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Rectal_bleeding" title="Rectal bleeding">Rectal bleeding</a> or <a href="/wiki/Anemia" title="Anemia">anemia</a> are high-risk symptoms in people over the age of 50.<sup id="cite_ref-Sym11_17-0" class="reference"><a href="#cite_note-Sym11-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup> Weight loss and changes in a person's bowel habit are typically only concerning if they are associated with rectal bleeding.<sup id="cite_ref-Sym11_17-1" class="reference"><a href="#cite_note-Sym11-17"><span class="cite-bracket">[</span>17<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid21624112_18-0" class="reference"><a href="#cite_note-pmid21624112-18"><span class="cite-bracket">[</span>18<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Cause">Cause</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=2" title="Edit section: Cause"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>75–95% of colorectal cancer cases occur in people with little or no genetic risk.<sup id="cite_ref-Cause11_19-0" class="reference"><a href="#cite_note-Cause11-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Lancet10_20-0" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Risk factors include older age, male sex,<sup id="cite_ref-Lancet10_20-1" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> high intake of fat, <a href="/wiki/Sugar" title="Sugar">sugar</a>, <a href="/wiki/Alcohol_(drug)" title="Alcohol (drug)">alcohol</a>, <a href="/wiki/Red_meat" title="Red meat">red meat</a>, <a href="/wiki/Processed_meat" title="Processed meat">processed meats</a>, <a href="/wiki/Obesity" title="Obesity">obesity</a>, <a href="/wiki/Smoking" title="Smoking">smoking</a>, and a lack of <a href="/wiki/Physical_exercise" class="mw-redirect" title="Physical exercise">physical exercise</a>.<sup id="cite_ref-Cause11_19-1" class="reference"><a href="#cite_note-Cause11-19"><span class="cite-bracket">[</span>19<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-WCRF2011_21-0" class="reference"><a href="#cite_note-WCRF2011-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup> The Rectal Cancer Survival Calculator developed by the <a href="/wiki/MD_Anderson_Cancer_Center" title="MD Anderson Cancer Center">MD Anderson Cancer Center</a> additionally considers race to be a risk factor; however, there are equity issues concerning whether this might lead to inequity in clinical decision making.<sup id="cite_ref-22" class="reference"><a href="#cite_note-22"><span class="cite-bracket">[</span>22<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">[</span>23<span class="cite-bracket">]</span></a></sup> Approximately 10% of cases are linked to insufficient activity.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">[</span>24<span class="cite-bracket">]</span></a></sup> The risk from alcohol appears to increase at greater than one drink per day.<sup id="cite_ref-Fedirko2011_25-0" class="reference"><a href="#cite_note-Fedirko2011-25"><span class="cite-bracket">[</span>25<span class="cite-bracket">]</span></a></sup> Drinking five glasses of water a day is linked to a decrease in the risk of colorectal cancer and <a href="/wiki/Adenomatous" class="mw-redirect" title="Adenomatous">adenomatous</a> polyps.<sup id="cite_ref-26" class="reference"><a href="#cite_note-26"><span class="cite-bracket">[</span>26<span class="cite-bracket">]</span></a></sup> The consumption of <a href="/wiki/Dairy_product" title="Dairy product">dairy products</a>, such as milk, is protective against colorectal cancer.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">[</span>27<span class="cite-bracket">]</span></a></sup> <i><a href="/wiki/Streptococcus_gallolyticus" class="mw-redirect" title="Streptococcus gallolyticus">Streptococcus gallolyticus</a></i> is associated with colorectal cancer.<sup id="cite_ref-BoleijvanGelder2011_28-0" class="reference"><a href="#cite_note-BoleijvanGelder2011-28"><span class="cite-bracket">[</span>28<span class="cite-bracket">]</span></a></sup> Some strains of <i>Streptococcus bovis/Streptococcus equinus</i> complex are consumed by millions of people daily and thus may be safe.<sup id="cite_ref-JansMeile2015_29-0" class="reference"><a href="#cite_note-JansMeile2015-29"><span class="cite-bracket">[</span>29<span class="cite-bracket">]</span></a></sup> 25 to 80% of people with <i>Streptococcus bovis/gallolyticus</i> bacteremia have concomitant colorectal tumors.<sup id="cite_ref-AbdulamirHafidh2011_30-0" class="reference"><a href="#cite_note-AbdulamirHafidh2011-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> Seroprevalence of <i>Streptococcus bovis/gallolyticus</i> is considered as a candidate practical marker for the early prediction of an underlying bowel lesion at high-risk population.<sup id="cite_ref-AbdulamirHafidh2011_30-1" class="reference"><a href="#cite_note-AbdulamirHafidh2011-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> It has been suggested that the presence of antibodies to <i>Streptococcus bovis/gallolyticus</i> antigens or the antigens themselves in the bloodstream may act as markers for the carcinogenesis in the colon.<sup id="cite_ref-AbdulamirHafidh2011_30-2" class="reference"><a href="#cite_note-AbdulamirHafidh2011-30"><span class="cite-bracket">[</span>30<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Pathogenic_Escherichia_coli" title="Pathogenic Escherichia coli">Pathogenic <i>Escherichia coli</i></a> may increase the risk of colorectal cancer by producing the <a href="/wiki/Genotoxicity" title="Genotoxicity">genotoxic</a> <a href="/wiki/Metabolite" title="Metabolite">metabolite</a>, <a href="/wiki/Colibactin" title="Colibactin">colibactin</a>.<sup id="cite_ref-pmid32317778_31-0" class="reference"><a href="#cite_note-pmid32317778-31"><span class="cite-bracket">[</span>31<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Inflammatory_bowel_disease">Inflammatory bowel disease</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=3" title="Edit section: Inflammatory bowel disease"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>People with <a href="/wiki/Inflammatory_bowel_disease" title="Inflammatory bowel disease">inflammatory bowel disease</a> (<a href="/wiki/Ulcerative_colitis" title="Ulcerative colitis">ulcerative colitis</a> and <a href="/wiki/Crohn%27s_disease" title="Crohn's disease">Crohn's disease</a>) are at increased risk of colon cancer.<sup id="cite_ref-IBD11_32-0" class="reference"><a href="#cite_note-IBD11-32"><span class="cite-bracket">[</span>32<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid26004415_33-0" class="reference"><a href="#cite_note-pmid26004415-33"><span class="cite-bracket">[</span>33<span class="cite-bracket">]</span></a></sup> The risk increases the longer a person has the disease, and the worse the severity of inflammation.<sup id="cite_ref-IBD09_34-0" class="reference"><a href="#cite_note-IBD09-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> In these high risk groups, both prevention with <a href="/wiki/Aspirin" title="Aspirin">aspirin</a> and regular <a href="/wiki/Colonoscopies" class="mw-redirect" title="Colonoscopies">colonoscopies</a> are recommended.<sup id="cite_ref-Bye-2017_35-0" class="reference"><a href="#cite_note-Bye-2017-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Endoscopic" class="mw-redirect" title="Endoscopic">Endoscopic</a> surveillance in this high-risk population may reduce the development of colorectal cancer through early diagnosis and may also reduce the chances of dying from colon cancer.<sup id="cite_ref-Bye-2017_35-1" class="reference"><a href="#cite_note-Bye-2017-35"><span class="cite-bracket">[</span>35<span class="cite-bracket">]</span></a></sup> People with inflammatory bowel disease account for less than 2% of colon cancer cases yearly.<sup id="cite_ref-IBD09_34-1" class="reference"><a href="#cite_note-IBD09-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> In those with Crohn's disease (with colonic involvement), 2% get colorectal cancer after 10 years, 8% after 20 years, and 18% after 30 years.<sup id="cite_ref-IBD09_34-2" class="reference"><a href="#cite_note-IBD09-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> In people who have ulcerative colitis, approximately 16% develop either a <a href="/wiki/Dysplasia" title="Dysplasia">cancer precursor</a> or cancer of the colon over 30 years.<sup id="cite_ref-IBD09_34-3" class="reference"><a href="#cite_note-IBD09-34"><span class="cite-bracket">[</span>34<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Genetics">Genetics</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=4" title="Edit section: Genetics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Those with a family history in two or more <a href="/wiki/Degree_of_relationship" class="mw-redirect" title="Degree of relationship">first-degree relatives</a> (such as a parent or sibling) have a two to threefold greater risk of disease, and this group accounts for about 20% of all cases. Several genetic syndromes are also associated with higher rates of colorectal cancer. The most common of these is <a href="/wiki/Hereditary_nonpolyposis_colorectal_cancer" title="Hereditary nonpolyposis colorectal cancer">hereditary nonpolyposis colorectal cancer</a> (HNPCC, or Lynch syndrome) which is present in about 3% of people with colorectal cancer.<sup id="cite_ref-Lancet10_20-2" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Other syndromes that are strongly associated with colorectal cancer include <a href="/wiki/Gardner_syndrome" class="mw-redirect" title="Gardner syndrome">Gardner syndrome</a> and <a href="/wiki/Familial_adenomatous_polyposis" title="Familial adenomatous polyposis">familial adenomatous polyposis</a> (FAP).<sup id="cite_ref-pmid20141232_36-0" class="reference"><a href="#cite_note-pmid20141232-36"><span class="cite-bracket">[</span>36<span class="cite-bracket">]</span></a></sup> For people with these syndromes, cancer almost always occurs and makes up 1% of the cancer cases.<sup id="cite_ref-pmid19822006_37-0" class="reference"><a href="#cite_note-pmid19822006-37"><span class="cite-bracket">[</span>37<span class="cite-bracket">]</span></a></sup> A total <a href="/wiki/Proctocolectomy" title="Proctocolectomy">proctocolectomy</a> may be recommended for people with FAP as a preventive measure due to the high risk of malignancy. Colectomy, the removal of the colon, may not suffice as a preventive measure because of the high risk of rectal cancer if the rectum remains.<sup id="cite_ref-38" class="reference"><a href="#cite_note-38"><span class="cite-bracket">[</span>38<span class="cite-bracket">]</span></a></sup> The most common polyposis syndrome affecting the colon is <a href="/wiki/Serrated_polyposis_syndrome" title="Serrated polyposis syndrome">serrated polyposis syndrome</a>,<sup id="cite_ref-Mankaney_39-0" class="reference"><a href="#cite_note-Mankaney-39"><span class="cite-bracket">[</span>39<span class="cite-bracket">]</span></a></sup> which is associated with a 25-40% risk of CRC.<sup id="cite_ref-Fan_40-0" class="reference"><a href="#cite_note-Fan-40"><span class="cite-bracket">[</span>40<span class="cite-bracket">]</span></a></sup> </p><p>Mutations in the pair of genes (<a href="/wiki/DNA_polymerase_epsilon" title="DNA polymerase epsilon">POLE</a> and <a href="/wiki/POLD1" title="POLD1">POLD1</a>) have been associated with familial colon cancer.<sup id="cite_ref-Bourdais2017_41-0" class="reference"><a href="#cite_note-Bourdais2017-41"><span class="cite-bracket">[</span>41<span class="cite-bracket">]</span></a></sup> </p><p>Most deaths due to colon cancer are associated with metastatic disease. A gene that appears to contribute to the potential for metastatic disease, metastasis associated in colon cancer 1 (<i>MACC1</i>), has been isolated.<sup id="cite_ref-Stein2009_42-0" class="reference"><a href="#cite_note-Stein2009-42"><span class="cite-bracket">[</span>42<span class="cite-bracket">]</span></a></sup> It is a <a href="/wiki/Transcriptional" class="mw-redirect" title="Transcriptional">transcriptional</a> factor that influences the expression of <a href="/wiki/Hepatocyte_growth_factor" title="Hepatocyte growth factor">hepatocyte growth factor</a>. This gene is associated with the proliferation, invasion, and scattering of colon cancer cells in <a href="/wiki/Cell_culture" title="Cell culture">cell culture</a>, and tumor growth and metastasis in mice. MACC1 may be a potential target for cancer intervention, but this possibility needs to be confirmed with clinical studies.<sup id="cite_ref-Stein2013_43-0" class="reference"><a href="#cite_note-Stein2013-43"><span class="cite-bracket">[</span>43<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Epigenetic" class="mw-redirect" title="Epigenetic">Epigenetic</a> factors, such as abnormal <a href="/wiki/DNA_methylation" title="DNA methylation">DNA methylation</a> of <a href="/wiki/Tumor_suppressor" class="mw-redirect" title="Tumor suppressor">tumor suppressor</a> promoters, play a role in the development of colorectal cancer.<sup id="cite_ref-44" class="reference"><a href="#cite_note-44"><span class="cite-bracket">[</span>44<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Ashkenazi_Jews" title="Ashkenazi Jews">Ashkenazi Jews</a> have a 6% higher risk rate of getting <a href="/wiki/Adenoma" title="Adenoma">adenomas</a> and then colon cancer due to mutations in the <a href="/wiki/APC_gene" class="mw-redirect" title="APC gene">APC gene</a> being more common.<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">[</span>45<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Pathogenesis">Pathogenesis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=5" title="Edit section: Pathogenesis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Colorectal cancer is a disease originating from the <a href="/wiki/Epithelium" title="Epithelium">epithelial cells</a> lining the colon or rectum of the <a href="/wiki/Human_gastrointestinal_tract" class="mw-redirect" title="Human gastrointestinal tract">gastrointestinal tract</a>, most frequently as a result of genetic mutations in the <a href="/wiki/Wnt_signaling_pathway" title="Wnt signaling pathway">Wnt signaling pathway</a> that increases signaling activity.<sup id="cite_ref-Tabibzadeh-2020_46-0" class="reference"><a href="#cite_note-Tabibzadeh-2020-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> The Wnt signaling pathway normally plays an important role for normal function of these cells including maintaining this lining. Mutations can be <a href="/wiki/Hereditary_disease" class="mw-redirect" title="Hereditary disease">inherited</a> or <a href="/wiki/Somatic_cell" title="Somatic cell">acquired</a>, and most probably occur in the <a href="/wiki/Intestinal_crypt" class="mw-redirect" title="Intestinal crypt">intestinal crypt</a> <a href="/wiki/Stem_cell" title="Stem cell">stem cell</a>.<sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">[</span>47<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">[</span>48<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-49" class="reference"><a href="#cite_note-49"><span class="cite-bracket">[</span>49<span class="cite-bracket">]</span></a></sup> The most commonly mutated gene in all colorectal cancer is the <i><a href="/wiki/Adenomatous_polyposis_coli" title="Adenomatous polyposis coli">APC</a></i> gene, which produces the APC protein.<sup id="cite_ref-Tabibzadeh-2020_46-1" class="reference"><a href="#cite_note-Tabibzadeh-2020-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> The APC protein prevents the accumulation of <a href="/wiki/%CE%92-catenin" class="mw-redirect" title="Β-catenin">β-catenin</a> protein. Without APC, <a href="/wiki/%CE%92-catenin" class="mw-redirect" title="Β-catenin">β-catenin</a> accumulates to high levels and translocates (moves) into the <a href="/wiki/Cell_nucleus" title="Cell nucleus">nucleus</a>, binds to DNA, and activates the <a href="/wiki/Transcription_(genetics)" class="mw-redirect" title="Transcription (genetics)">transcription</a> of proto-<a href="/wiki/Oncogenes" class="mw-redirect" title="Oncogenes">oncogenes</a>. These genes are normally important for stem cell renewal and differentiation, but when inappropriately expressed at high levels, they can cause cancer.<sup id="cite_ref-Tabibzadeh-2020_46-2" class="reference"><a href="#cite_note-Tabibzadeh-2020-46"><span class="cite-bracket">[</span>46<span class="cite-bracket">]</span></a></sup> While APC is mutated in most colon cancers, some cancers have increased β-catenin because of mutations in β-catenin (CTNNB1) that block its breakdown, or have mutations in other genes with function similar to APC such as <a href="/wiki/AXIN1" title="AXIN1">AXIN1</a>, <a href="/wiki/AXIN2" title="AXIN2">AXIN2</a>, <a href="/wiki/TCF7L2" title="TCF7L2">TCF7L2</a>, or <a href="/wiki/Naked_cuticle_1" title="Naked cuticle 1">NKD1</a>.<sup id="cite_ref-markowitz_50-0" class="reference"><a href="#cite_note-markowitz-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> </p><p>Beyond the defects in the <a href="/wiki/Wnt_signaling_pathway" title="Wnt signaling pathway">Wnt signaling pathway</a>, other mutations must occur for the cell to become cancerous. The <a href="/wiki/P53" title="P53">p53</a> protein, produced by the <i>TP53</i> gene, normally monitors <a href="/wiki/Cell_division" title="Cell division">cell division</a> and induces their <a href="/wiki/Apoptosis" title="Apoptosis">programmed death</a> if they have Wnt pathway defects. Eventually, a <a href="/wiki/Cell_line" class="mw-redirect" title="Cell line">cell line</a> acquires a mutation in the <i>TP53</i> gene and transforms the tissue from a <a href="/wiki/Adenoma" title="Adenoma">benign epithelial tumor</a> into an invasive <a href="/wiki/Carcinoma" title="Carcinoma">epithelial cell cancer</a>. Sometimes the gene encoding p53 is not mutated, but another protective protein named <a href="/wiki/BAX_(gene)" class="mw-redirect" title="BAX (gene)">BAX</a> is mutated instead.<sup id="cite_ref-markowitz_50-1" class="reference"><a href="#cite_note-markowitz-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> </p><p>Other proteins responsible for programmed cell death that are commonly deactivated in colorectal cancers are <a href="/wiki/TGF-%CE%B2" class="mw-redirect" title="TGF-β">TGF-β</a> and DCC (<a href="/wiki/Deleted_in_Colorectal_Cancer" class="mw-redirect" title="Deleted in Colorectal Cancer">Deleted in Colorectal Cancer</a>). TGF-β has a deactivating mutation in at least half of colorectal cancers. Sometimes TGF-β is not deactivated, but a downstream protein named <a href="/wiki/SMAD_(protein)" title="SMAD (protein)">SMAD</a> is deactivated.<sup id="cite_ref-markowitz_50-2" class="reference"><a href="#cite_note-markowitz-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> DCC commonly has a deleted segment of a chromosome in colorectal cancer.<sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">[</span>51<span class="cite-bracket">]</span></a></sup> </p><p>Approximately 70% of all <a href="/wiki/Human_gene" class="mw-redirect" title="Human gene">human genes</a> are expressed in colorectal cancer, with just over 1% having increased expression in colorectal cancer compared to other forms of cancer.<sup id="cite_ref-Uh2017_52-0" class="reference"><a href="#cite_note-Uh2017-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> Some genes are <a href="/wiki/Oncogenes" class="mw-redirect" title="Oncogenes">oncogenes</a>: they are overexpressed in colorectal cancer. For example, genes encoding the proteins <a href="/wiki/KRAS" title="KRAS">KRAS</a>, <a href="/wiki/C-Raf" title="C-Raf">RAF</a>, and <a href="/wiki/PI3K" class="mw-redirect" title="PI3K">PI3K</a>, which normally stimulate the <a href="/wiki/Cell_cycle" title="Cell cycle">cell to divide</a> in response to growth factors, can acquire mutations that result in over-activation of cell proliferation. The chronological order of mutations is sometimes important. If a previous APC mutation occurred, a primary KRAS mutation often progresses to cancer rather than a self-limiting <a href="/wiki/Hyperplastic" class="mw-redirect" title="Hyperplastic">hyperplastic</a> or borderline lesion.<sup id="cite_ref-53" class="reference"><a href="#cite_note-53"><span class="cite-bracket">[</span>53<span class="cite-bracket">]</span></a></sup> <a href="/wiki/PTEN_(gene)" title="PTEN (gene)">PTEN</a>, a tumor suppressor, normally inhibits PI3K, but can sometimes become mutated and deactivated.<sup id="cite_ref-markowitz_50-3" class="reference"><a href="#cite_note-markowitz-50"><span class="cite-bracket">[</span>50<span class="cite-bracket">]</span></a></sup> </p><p>Comprehensive, <a href="/wiki/Genome" title="Genome">genome</a>-scale analysis has revealed that colorectal carcinomas can be categorized into hypermutated and non-hypermutated tumor types.<sup id="cite_ref-Muzny-2012_54-0" class="reference"><a href="#cite_note-Muzny-2012-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> In addition to the oncogenic and inactivating mutations described for the genes above, non-hypermutated samples also contain mutated <a href="/wiki/CTNNB1" class="mw-redirect" title="CTNNB1">CTNNB1</a>, <a href="/wiki/FAM123B" title="FAM123B">FAM123B</a>, <a href="/wiki/SOX9" title="SOX9">SOX9</a>, <a href="/wiki/Ataxia_telangiectasia_mutated" class="mw-redirect" title="Ataxia telangiectasia mutated">ATM</a>, and <a href="/wiki/ARID1A" title="ARID1A">ARID1A</a>. Progressing through a distinct set of genetic events, hypermutated tumors display mutated forms of <a href="/wiki/ACVR2A" title="ACVR2A">ACVR2A</a>, <a href="/wiki/TGFBR2" class="mw-redirect" title="TGFBR2">TGFBR2</a>, <a href="/wiki/MSH3" title="MSH3">MSH3</a>, <a href="/wiki/MSH6" title="MSH6">MSH6</a>, SLC9A9, <a href="/wiki/TCF7L2" title="TCF7L2">TCF7L2</a>, and <a href="/wiki/BRAF_(gene)" title="BRAF (gene)">BRAF</a>. The common theme among these genes, across both tumor types, is their involvement in Wnt and TGF-β signaling pathways, which results in increased activity of <a href="/wiki/MYC" title="MYC">MYC</a>, a central player in colorectal cancer.<sup id="cite_ref-Muzny-2012_54-1" class="reference"><a href="#cite_note-Muzny-2012-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/DNA_mismatch_repair" title="DNA mismatch repair">Mismatch repair</a> (MMR) deficient tumours are characterized by a relatively high number of poly-nucleotide <a href="/wiki/Tandem_repeat" title="Tandem repeat">tandem repeats</a>.<sup id="cite_ref-55" class="reference"><a href="#cite_note-55"><span class="cite-bracket">[</span>55<span class="cite-bracket">]</span></a></sup> This is caused by a deficiency in MMR proteins – which are typically caused by <a href="/wiki/Epigenetics" title="Epigenetics">epigenetic</a> silencing and or inherited mutations (<i>e.g.</i>, <a href="/wiki/Hereditary_nonpolyposis_colorectal_cancer" title="Hereditary nonpolyposis colorectal cancer">Lynch syndrome</a>).<sup id="cite_ref-Ryan-2017_56-0" class="reference"><a href="#cite_note-Ryan-2017-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> 15 to 18 percent of colorectal cancer tumours have MMR deficiencies, with 3 percent developing due to Lynch syndrome.<sup id="cite_ref-57" class="reference"><a href="#cite_note-57"><span class="cite-bracket">[</span>57<span class="cite-bracket">]</span></a></sup> The role of the mismatch repair system is to protect the integrity of the genetic material within cells (<i>i.e.</i>, error detecting and correcting).<sup id="cite_ref-Ryan-2017_56-1" class="reference"><a href="#cite_note-Ryan-2017-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> Consequently, a deficiency in MMR proteins may lead to an inability to detect and repair genetic damage, allowing for further cancer-causing mutations to occur and colorectal cancer to progress.<sup id="cite_ref-Ryan-2017_56-2" class="reference"><a href="#cite_note-Ryan-2017-56"><span class="cite-bracket">[</span>56<span class="cite-bracket">]</span></a></sup> </p><p>The polyp to cancer progression sequence is the classical model of colorectal cancer <a href="/wiki/Pathogenesis" title="Pathogenesis">pathogenesis</a>.<sup id="cite_ref-Grady-2015_58-0" class="reference"><a href="#cite_note-Grady-2015-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> In this <b>adenoma-carcinoma sequence</b>,<sup id="cite_ref-59" class="reference"><a href="#cite_note-59"><span class="cite-bracket">[</span>59<span class="cite-bracket">]</span></a></sup> normal epithelial cells progress to <a href="/wiki/Dysplastic" class="mw-redirect" title="Dysplastic">dysplastic</a> cells such as <a href="/wiki/Adenoma" title="Adenoma">adenomas</a>, and then to carcinoma, by a process of progressive genetic mutation.<sup id="cite_ref-60" class="reference"><a href="#cite_note-60"><span class="cite-bracket">[</span>60<span class="cite-bracket">]</span></a></sup> Central to the polyp to CRC sequence are gene mutations, epigenetic alterations, and local inflammatory changes.<sup id="cite_ref-Grady-2015_58-1" class="reference"><a href="#cite_note-Grady-2015-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> The polyp to CRC sequence can be used as an underlying framework to illustrate how specific molecular changes lead to various cancer subtypes.<sup id="cite_ref-Grady-2015_58-2" class="reference"><a href="#cite_note-Grady-2015-58"><span class="cite-bracket">[</span>58<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Field_defects">Field defects</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=6" title="Edit section: Field defects"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Image_of_resected_colon_segment_with_cancer_%26_4_nearby_polyps_plus_schematic_of_field_defects_with_sub-clones.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e8/Image_of_resected_colon_segment_with_cancer_%26_4_nearby_polyps_plus_schematic_of_field_defects_with_sub-clones.jpg/220px-Image_of_resected_colon_segment_with_cancer_%26_4_nearby_polyps_plus_schematic_of_field_defects_with_sub-clones.jpg" decoding="async" width="220" height="337" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/e8/Image_of_resected_colon_segment_with_cancer_%26_4_nearby_polyps_plus_schematic_of_field_defects_with_sub-clones.jpg/330px-Image_of_resected_colon_segment_with_cancer_%26_4_nearby_polyps_plus_schematic_of_field_defects_with_sub-clones.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/e8/Image_of_resected_colon_segment_with_cancer_%26_4_nearby_polyps_plus_schematic_of_field_defects_with_sub-clones.jpg/440px-Image_of_resected_colon_segment_with_cancer_%26_4_nearby_polyps_plus_schematic_of_field_defects_with_sub-clones.jpg 2x" data-file-width="1672" data-file-height="2560" /></a><figcaption>Longitudinally opened freshly resected colon segment showing a cancer and four polyps. Plus a schematic diagram indicating a likely field defect (a region of tissue that precedes and predisposes to the development of cancer) in this colon segment. The diagram indicates sub-clones and sub-sub-clones that were precursors to the tumors.</figcaption></figure> <p>The term "field cancerization" was first used in 1953 to describe an area or "field" of epithelium that has been preconditioned (by what were largely unknown processes at the time) to predispose it towards the development of cancer.<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">[</span>61<span class="cite-bracket">]</span></a></sup> Since then, the terms "field cancerization", "field carcinogenesis", "field defect", and "<a href="/wiki/Field_cancerization" title="Field cancerization">field effect</a>" have been used to describe pre-malignant or pre-neoplastic tissue in which new cancers are likely to arise.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">[</span>62<span class="cite-bracket">]</span></a></sup> </p><p>Field defects are important in the progression of colon cancer.<sup id="cite_ref-63" class="reference"><a href="#cite_note-63"><span class="cite-bracket">[</span>63<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-64" class="reference"><a href="#cite_note-64"><span class="cite-bracket">[</span>64<span class="cite-bracket">]</span></a></sup> </p><p>However, as pointed out by Rubin, "The vast majority of studies in cancer research has been done on well-defined tumors <i>in vivo</i>, or on discrete neoplastic foci <i>in vitro</i>. Yet there is evidence that more than 80% of the somatic mutations found in mutator phenotype human colorectal tumors occur before the onset of terminal clonal expansion."<sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">[</span>65<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-66" class="reference"><a href="#cite_note-66"><span class="cite-bracket">[</span>66<span class="cite-bracket">]</span></a></sup> Similarly, Vogelstein et al.<sup id="cite_ref-Vogelstein_67-0" class="reference"><a href="#cite_note-Vogelstein-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> pointed out that more than half of somatic mutations identified in tumors occurred in a pre-neoplastic phase (in a field defect), during growth of apparently normal cells. Likewise, epigenetic alterations present in tumors may have occurred in pre-neoplastic field defects.<sup id="cite_ref-Bernstein-2013_68-0" class="reference"><a href="#cite_note-Bernstein-2013-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> </p><p>An expanded view of field effect has been termed "etiologic field effect", which encompasses not only molecular and pathologic changes in pre-neoplastic cells but also influences of exogenous environmental factors and molecular changes in the local <a href="/wiki/Tumor_microenvironment" title="Tumor microenvironment">microenvironment</a> on neoplastic evolution from tumor initiation to death.<sup id="cite_ref-69" class="reference"><a href="#cite_note-69"><span class="cite-bracket">[</span>69<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Epigenetics">Epigenetics</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=7" title="Edit section: Epigenetics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Epigenetics" title="Epigenetics">Epigenetic</a> alterations are much more frequent in colon cancer than genetic (mutational) alterations. As described by Vogelstein et al.,<sup id="cite_ref-Vogelstein_67-1" class="reference"><a href="#cite_note-Vogelstein-67"><span class="cite-bracket">[</span>67<span class="cite-bracket">]</span></a></sup> an average cancer of the colon has only 1 or 2 oncogene mutations and 1 to 5 tumor suppressor mutations (together designated "driver mutations"), with about 60 further "passenger" mutations. The oncogenes and tumor suppressor genes are well studied and are described above under <a href="#Pathogenesis">Pathogenesis</a>.<sup id="cite_ref-70" class="reference"><a href="#cite_note-70"><span class="cite-bracket">[</span>70<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-71" class="reference"><a href="#cite_note-71"><span class="cite-bracket">[</span>71<span class="cite-bracket">]</span></a></sup> </p><p>In addition to epigenetic alteration of expression of miRNAs, other common types of epigenetic alterations in cancers that change gene expression levels include direct hypermethylation or hypomethylation of CpG islands of protein-encoding genes and alterations in histones and chromosomal architecture that influence gene expression.<sup id="cite_ref-72" class="reference"><a href="#cite_note-72"><span class="cite-bracket">[</span>72<span class="cite-bracket">]</span></a></sup> As an example, 147 hypermethylations and 27 hypomethylations of protein-coding genes were frequently associated with colorectal cancers. Of the hypermethylated genes, 10 were hypermethylated in 100% of colon cancers, and many others were hypermethylated in more than 50% of colon cancers.<sup id="cite_ref-Sch_73-0" class="reference"><a href="#cite_note-Sch-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup> In addition, 11 hypermethylations and 96 hypomethylations of miRNAs were also associated with colorectal cancers.<sup id="cite_ref-Sch_73-1" class="reference"><a href="#cite_note-Sch-73"><span class="cite-bracket">[</span>73<span class="cite-bracket">]</span></a></sup> Abnormal (aberrant) <a href="/wiki/Methylation" title="Methylation">methylation</a> occurs as a normal consequence of normal aging and the risk of colorectal cancer increases as a person gets older.<sup id="cite_ref-Epigenetics_74-0" class="reference"><a href="#cite_note-Epigenetics-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> The source and trigger of this age-related methylation is unknown.<sup id="cite_ref-Epigenetics_74-1" class="reference"><a href="#cite_note-Epigenetics-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-75" class="reference"><a href="#cite_note-75"><span class="cite-bracket">[</span>75<span class="cite-bracket">]</span></a></sup> Approximately half of the genes that show age-related methylation changes are the same genes that have been identified to be involved in the development of colorectal cancer.<sup id="cite_ref-Epigenetics_74-2" class="reference"><a href="#cite_note-Epigenetics-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> These findings may suggest a reason for age being associated with the increased risk of developing colorectal cancer.<sup id="cite_ref-Epigenetics_74-3" class="reference"><a href="#cite_note-Epigenetics-74"><span class="cite-bracket">[</span>74<span class="cite-bracket">]</span></a></sup> </p><p>Epigenetic reductions of DNA repair enzyme expression may likely lead to the genomic and epigenomic instability characteristic of cancer.<sup id="cite_ref-76" class="reference"><a href="#cite_note-76"><span class="cite-bracket">[</span>76<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-77" class="reference"><a href="#cite_note-77"><span class="cite-bracket">[</span>77<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Bernstein-2013_68-1" class="reference"><a href="#cite_note-Bernstein-2013-68"><span class="cite-bracket">[</span>68<span class="cite-bracket">]</span></a></sup> As summarized in the articles <a href="/wiki/Carcinogenesis" title="Carcinogenesis">Carcinogenesis</a> and <a href="/wiki/Neoplasm" title="Neoplasm">Neoplasm</a>, for sporadic cancers in general, a deficiency in DNA repair is occasionally due to a mutation in a DNA repair gene, but is much more frequently due to epigenetic alterations that reduce or silence expression of DNA repair genes.<sup id="cite_ref-78" class="reference"><a href="#cite_note-78"><span class="cite-bracket">[</span>78<span class="cite-bracket">]</span></a></sup> </p><p>Epigenetic alterations involved in the development of colorectal cancer may affect a person's response to chemotherapy.<sup id="cite_ref-79" class="reference"><a href="#cite_note-79"><span class="cite-bracket">[</span>79<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Genomics_and_epigenomics">Genomics and epigenomics</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=8" title="Edit section: Genomics and epigenomics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Consensus molecular subtypes (CMS) classification of colorectal cancer was first introduced in 2015. CMS classification so far has been considered the most robust classification system available for CRC that has a clear biological interpretability and the basis for future clinical stratification and subtype-based targeted interventions.<sup id="cite_ref-80" class="reference"><a href="#cite_note-80"><span class="cite-bracket">[</span>80<span class="cite-bracket">]</span></a></sup> </p><p>A novel Epigenome-based Classification (EpiC) of colorectal cancer was proposed in 2021 introducing 4 enhancer subtypes in people with CRC. Chromatin states using 6 histone marks are characterized to identify EpiC subtypes. A combinatorial therapeutic approach based on the previously introduced consensus molecular subtypes (CMSs) and EpiCs could significantly enhance current treatment strategies.<sup id="cite_ref-81" class="reference"><a href="#cite_note-81"><span class="cite-bracket">[</span>81<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=9" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:ColonCaWithMetsMark.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/78/ColonCaWithMetsMark.png/220px-ColonCaWithMetsMark.png" decoding="async" width="220" height="239" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/78/ColonCaWithMetsMark.png/330px-ColonCaWithMetsMark.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/78/ColonCaWithMetsMark.png/440px-ColonCaWithMetsMark.png 2x" data-file-width="963" data-file-height="1045" /></a><figcaption>Colon cancer with extensive metastases to the liver</figcaption></figure> <p>Colorectal cancer diagnosis is performed by sampling areas of the colon suspicious for possible tumor development, typically during colonoscopy or sigmoidoscopy, depending on the location of the lesion.<sup id="cite_ref-Lancet10_20-3" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medical_imaging">Medical imaging</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=10" title="Edit section: Medical imaging"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A colorectal cancer is sometimes initially discovered on <a href="/wiki/CT_scan" title="CT scan">CT scan</a>.<sup id="cite_ref-Colorectal_Cancer_82-0" class="reference"><a href="#cite_note-Colorectal_Cancer-82"><span class="cite-bracket">[</span>82<span class="cite-bracket">]</span></a></sup> </p><p>The presence of <a href="/wiki/Metastasis" title="Metastasis">metastases</a> is determined by a <a href="/wiki/X-ray_computed_tomography" class="mw-redirect" title="X-ray computed tomography">CT scan</a> of the chest, abdomen, and pelvis.<sup id="cite_ref-Lancet10_20-4" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Other potential imaging tests such as <a href="/wiki/Positron_emission_tomography" title="Positron emission tomography">PET</a> and <a href="/wiki/MRI" class="mw-redirect" title="MRI">MRI</a> may be used in certain cases.<sup id="cite_ref-Lancet10_20-5" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> MRI is particularly useful to determine the local stage of the tumor and to plan the optimal surgical approach.<sup id="cite_ref-Colorectal_Cancer_82-1" class="reference"><a href="#cite_note-Colorectal_Cancer-82"><span class="cite-bracket">[</span>82<span class="cite-bracket">]</span></a></sup> </p><p>MRI is also performed after completion of neoadjuvant chemoradiotherapy to identify patients who achieve a complete response. Patients with a complete response on both MRI and endoscopy may not require surgical resection and can avoid unnecessary surgical morbidity and complications.<sup id="cite_ref-83" class="reference"><a href="#cite_note-83"><span class="cite-bracket">[</span>83<span class="cite-bracket">]</span></a></sup> Patients selected for non-surgical treatment of rectal cancer should have periodic MRI scans, receive physical examinations, and undergo endoscopy procedures to detect any tumor re-growth which can occur in a minority of these patients. When local recurrence occurs, periodic follow-up can detect it when it is still small and curable with salvage surgery. In addition, MRI tumor regression grades can be assigned after chemoradiotherapy which correlate with patients' long-term survival outcomes.<sup id="cite_ref-84" class="reference"><a href="#cite_note-84"><span class="cite-bracket">[</span>84<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Histopathology">Histopathology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=11" title="Edit section: Histopathology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Relative_incidence_of_colorectal_cancers.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/3/36/Relative_incidence_of_colorectal_cancers.svg/220px-Relative_incidence_of_colorectal_cancers.svg.png" decoding="async" width="220" height="79" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/3/36/Relative_incidence_of_colorectal_cancers.svg/330px-Relative_incidence_of_colorectal_cancers.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/3/36/Relative_incidence_of_colorectal_cancers.svg/440px-Relative_incidence_of_colorectal_cancers.svg.png 2x" data-file-width="1570" data-file-height="566" /></a><figcaption>Relative incidence of various histopathological types of colorectal cancer. The vast majority of colorectal cancers are <a href="/wiki/Adenocarcinoma" title="Adenocarcinoma">adenocarcinomas</a>.<sup id="cite_ref-85" class="reference"><a href="#cite_note-85"><span class="cite-bracket">[</span>85<span class="cite-bracket">]</span></a></sup></figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Micrograph_of_colorectal_carcinoma_with_dirty_necrosis.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e8/Micrograph_of_colorectal_carcinoma_with_dirty_necrosis.jpg/220px-Micrograph_of_colorectal_carcinoma_with_dirty_necrosis.jpg" decoding="async" width="220" height="188" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/e8/Micrograph_of_colorectal_carcinoma_with_dirty_necrosis.jpg/330px-Micrograph_of_colorectal_carcinoma_with_dirty_necrosis.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/e8/Micrograph_of_colorectal_carcinoma_with_dirty_necrosis.jpg/440px-Micrograph_of_colorectal_carcinoma_with_dirty_necrosis.jpg 2x" data-file-width="773" data-file-height="659" /></a><figcaption>Micrograph of colorectal adenocarcinoma, showing "dirty necrosis".</figcaption></figure> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Further information: <a href="/wiki/Histopathology_of_colorectal_adenocarcinoma" title="Histopathology of colorectal adenocarcinoma">Histopathology of colorectal adenocarcinoma</a></div> <p>The <a href="/wiki/Histopathology" title="Histopathology">histopathologic</a> characteristics of the <a href="/wiki/Tumor" class="mw-redirect" title="Tumor">tumor</a> are reported from the analysis of tissue taken from a biopsy or surgery. A pathology report contains a description of the microscopical characteristics of the tumor tissue, including both tumor cells and how the tumor invades into healthy tissues and finally if the tumor appears to be completely removed. The most common form of colon cancer is <a href="/wiki/Adenocarcinoma" title="Adenocarcinoma">adenocarcinoma</a>, constituting between 95%<sup id="cite_ref-86" class="reference"><a href="#cite_note-86"><span class="cite-bracket">[</span>86<span class="cite-bracket">]</span></a></sup> and 98%<sup id="cite_ref-87" class="reference"><a href="#cite_note-87"><span class="cite-bracket">[</span>87<span class="cite-bracket">]</span></a></sup> of all cases of colorectal cancer. Other, rarer types include <a href="/wiki/Lymphoma" title="Lymphoma">lymphoma</a>, adenosquamous, and <a href="/wiki/Squamous_cell_carcinoma" class="mw-redirect" title="Squamous cell carcinoma">squamous cell carcinoma</a>. Some subtypes are more aggressive.<sup id="cite_ref-88" class="reference"><a href="#cite_note-88"><span class="cite-bracket">[</span>88<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Immunohistochemistry" title="Immunohistochemistry">Immunohistochemistry</a> may be used in uncertain cases.<sup id="cite_ref-89" class="reference"><a href="#cite_note-89"><span class="cite-bracket">[</span>89<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Staging">Staging</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=12" title="Edit section: Staging"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Colon_cancer_staging" title="Colon cancer staging">Colon cancer staging</a></div> <p><a href="/wiki/Cancer_staging" title="Cancer staging">Staging</a> of the cancer is based on both radiological and pathological findings. As with most other forms of cancer, tumor staging is based on the <a href="/wiki/TNM_staging_system" title="TNM staging system">TNM system</a> which considers how much the initial tumor has spread and the presence of metastases in lymph nodes and more distant organs.<sup id="cite_ref-Lancet10_20-6" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> The AJCC 8th edition was published in 2018.<sup id="cite_ref-90" class="reference"><a href="#cite_note-90"><span class="cite-bracket">[</span>90<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=13" title="Edit section: Prevention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>It has been estimated that about half of colorectal cancer cases are due to lifestyle factors, and about a quarter of all cases are preventable.<sup id="cite_ref-91" class="reference"><a href="#cite_note-91"><span class="cite-bracket">[</span>91<span class="cite-bracket">]</span></a></sup> Increasing surveillance, engaging in physical activity, consuming a diet high in fiber, quitting smoking and limiting alcohol consumption decrease the risk.<sup id="cite_ref-92" class="reference"><a href="#cite_note-92"><span class="cite-bracket">[</span>92<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-93" class="reference"><a href="#cite_note-93"><span class="cite-bracket">[</span>93<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Lifestyle">Lifestyle</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=14" title="Edit section: Lifestyle"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Lifestyle risk factors with strong evidence include lack of exercise, cigarette smoking, alcohol, and obesity.<sup id="cite_ref-NCI2018Overview_94-0" class="reference"><a href="#cite_note-NCI2018Overview-94"><span class="cite-bracket">[</span>94<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-WHOcancerprevention_95-0" class="reference"><a href="#cite_note-WHOcancerprevention-95"><span class="cite-bracket">[</span>95<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-96" class="reference"><a href="#cite_note-96"><span class="cite-bracket">[</span>96<span class="cite-bracket">]</span></a></sup> The risk of colon cancer can be reduced by maintaining a normal body weight through a combination of sufficient exercise and eating a <a href="/wiki/Healthy_diet" title="Healthy diet">healthy diet</a>.<sup id="cite_ref-97" class="reference"><a href="#cite_note-97"><span class="cite-bracket">[</span>97<span class="cite-bracket">]</span></a></sup> </p><p>Current research consistently links eating more red meat and processed meat to a higher risk of the disease.<sup id="cite_ref-98" class="reference"><a href="#cite_note-98"><span class="cite-bracket">[</span>98<span class="cite-bracket">]</span></a></sup> Starting in the 1970s, dietary recommendations to prevent colorectal cancer often included increasing the consumption of <a href="/wiki/Whole_grain" title="Whole grain">whole grains</a>, fruits and vegetables, and reducing the intake of <a href="/wiki/Red_meat" title="Red meat">red meat</a> and <a href="/wiki/Processed_meat" title="Processed meat">processed meats</a>. This was based on animal studies and retrospective observational studies. However, large-scale prospective studies have failed to demonstrate a significant protective effect, and due to the multiple causes of cancer and the complexity of studying correlations between diet and health, it is uncertain whether any specific dietary interventions will have significant protective effects.<sup id="cite_ref-WCR2014Willett_99-0" class="reference"><a href="#cite_note-WCR2014Willett-99"><span class="cite-bracket">[</span>99<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 432–433">: 432–433 </span></sup><sup id="cite_ref-WCR2014_2.6_100-0" class="reference"><a href="#cite_note-WCR2014_2.6-100"><span class="cite-bracket">[</span>100<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 125–126">: 125–126 </span></sup> In 2018 the <a href="/wiki/National_Cancer_Institute" title="National Cancer Institute">National Cancer Institute</a> stated that "There is no reliable evidence that a diet started in adulthood that is low in fat and meat and high in fiber, fruits, and vegetables reduces the risk of CRC by a clinically important degree."<sup id="cite_ref-NCI2018Overview_94-1" class="reference"><a href="#cite_note-NCI2018Overview-94"><span class="cite-bracket">[</span>94<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-NCI2018Evidence_101-0" class="reference"><a href="#cite_note-NCI2018Evidence-101"><span class="cite-bracket">[</span>101<span class="cite-bracket">]</span></a></sup> </p><p>Consuming alcoholic drinks and consuming processed meat both increase the risk of colorectal cancer.<sup id="cite_ref-w151_102-0" class="reference"><a href="#cite_note-w151-102"><span class="cite-bracket">[</span>102<span class="cite-bracket">]</span></a></sup> </p><p>The 2014 World Health Organization cancer report noted that it has been hypothesized that dietary fiber might help prevent colorectal cancer, but that most studies at the time had not yet studied the correlation.<sup id="cite_ref-WCR2014_2.6_100-1" class="reference"><a href="#cite_note-WCR2014_2.6-100"><span class="cite-bracket">[</span>100<span class="cite-bracket">]</span></a></sup> A 2019 review, however, found evidence of benefit from dietary fiber and whole grains.<sup id="cite_ref-103" class="reference"><a href="#cite_note-103"><span class="cite-bracket">[</span>103<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/World_Cancer_Research_Fund" title="World Cancer Research Fund">World Cancer Research Fund</a> listed the benefit of fiber for prevention of colorectal cancer as "probable" as of 2017.<sup id="cite_ref-Song2018_104-0" class="reference"><a href="#cite_note-Song2018-104"><span class="cite-bracket">[</span>104<span class="cite-bracket">]</span></a></sup> A 2022 <a href="/wiki/Umbrella_review" title="Umbrella review">umbrella review</a> says there is "convincing evidence" for that association.<sup id="cite_ref-105" class="reference"><a href="#cite_note-105"><span class="cite-bracket">[</span>105<span class="cite-bracket">]</span></a></sup> </p><p>Higher physical activity is recommended.<sup id="cite_ref-WCRF2011_21-1" class="reference"><a href="#cite_note-WCRF2011-21"><span class="cite-bracket">[</span>21<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-106" class="reference"><a href="#cite_note-106"><span class="cite-bracket">[</span>106<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Physical_exercise" class="mw-redirect" title="Physical exercise">Physical exercise</a> is associated with a modest reduction in colon but not rectal cancer risk.<sup id="cite_ref-pmid19207713_107-0" class="reference"><a href="#cite_note-pmid19207713-107"><span class="cite-bracket">[</span>107<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-108" class="reference"><a href="#cite_note-108"><span class="cite-bracket">[</span>108<span class="cite-bracket">]</span></a></sup> High levels of physical activity reduce the risk of colon cancer by about 21%.<sup id="cite_ref-BMJ2016_109-0" class="reference"><a href="#cite_note-BMJ2016-109"><span class="cite-bracket">[</span>109<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Sitting" title="Sitting">Sitting</a> regularly for prolonged periods is associated with higher mortality from colon cancer. Regular exercise does not negate the risk but does lower it.<sup id="cite_ref-Biswas_110-0" class="reference"><a href="#cite_note-Biswas-110"><span class="cite-bracket">[</span>110<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Medication_and_supplements">Medication and supplements</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=15" title="Edit section: Medication and supplements"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Aspirin" title="Aspirin">Aspirin</a> and <a href="/wiki/Celecoxib" title="Celecoxib">celecoxib</a> appear to decrease the risk of colorectal cancer in those at high risk.<sup id="cite_ref-pmid20594533_111-0" class="reference"><a href="#cite_note-pmid20594533-111"><span class="cite-bracket">[</span>111<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-112" class="reference"><a href="#cite_note-112"><span class="cite-bracket">[</span>112<span class="cite-bracket">]</span></a></sup> Aspirin is recommended in those who are 50 to 60 years old, do not have an increased risk of bleeding, and are at risk for cardiovascular disease to prevent colorectal cancer.<sup id="cite_ref-113" class="reference"><a href="#cite_note-113"><span class="cite-bracket">[</span>113<span class="cite-bracket">]</span></a></sup> It is not recommended in those at average risk.<sup id="cite_ref-114" class="reference"><a href="#cite_note-114"><span class="cite-bracket">[</span>114<span class="cite-bracket">]</span></a></sup> </p><p>There is tentative evidence for <a href="/wiki/Calcium" title="Calcium">calcium</a> supplementation, but it is insufficient to make a recommendation.<sup id="cite_ref-pmid18254022_115-0" class="reference"><a href="#cite_note-pmid18254022-115"><span class="cite-bracket">[</span>115<span class="cite-bracket">]</span></a></sup> </p><p>Adequate <a href="/wiki/Vitamin_D" title="Vitamin D">Vitamin D</a> intake and blood levels are associated with a lower risk of colon cancer.<sup id="cite_ref-pmid21876081_116-0" class="reference"><a href="#cite_note-pmid21876081-116"><span class="cite-bracket">[</span>116<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid21672549_117-0" class="reference"><a href="#cite_note-pmid21672549-117"><span class="cite-bracket">[</span>117<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Screening">Screening</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=16" title="Edit section: Screening"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>As more than 80% of colorectal cancers arise from <a href="/wiki/Adenomatous_polyps" class="mw-redirect" title="Adenomatous polyps">adenomatous polyps</a>, screening for this cancer is effective for both early detection and prevention.<sup id="cite_ref-Lancet10_20-7" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-cdcprevent_118-0" class="reference"><a href="#cite_note-cdcprevent-118"><span class="cite-bracket">[</span>118<span class="cite-bracket">]</span></a></sup> Diagnosis of cases of colorectal cancer through screening tends to occur 2–3 years before diagnosis of cases with symptoms.<sup id="cite_ref-Lancet10_20-8" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Any polyps that are detected can be removed, usually by <a href="/wiki/Colonoscopy" title="Colonoscopy">colonoscopy</a> or <a href="/wiki/Sigmoidoscopy" title="Sigmoidoscopy">sigmoidoscopy</a>, and thus prevent them from turning into cancer. Screening has the potential to reduce colorectal cancer deaths by 60%.<sup id="cite_ref-Screen11_119-0" class="reference"><a href="#cite_note-Screen11-119"><span class="cite-bracket">[</span>119<span class="cite-bracket">]</span></a></sup> </p><p>The three main screening tests are colonoscopy, <a href="/wiki/Fecal_occult_blood" title="Fecal occult blood">fecal occult blood</a> testing, and <a href="/wiki/Flexible_sigmoidoscopy" class="mw-redirect" title="Flexible sigmoidoscopy">flexible sigmoidoscopy</a>. Of the three, only sigmoidoscopy cannot screen the <a href="/wiki/Colon_(anatomy)#Right_and_Left_Colon" class="mw-redirect" title="Colon (anatomy)">right side of the colon</a> where 42% of cancers are found.<sup id="cite_ref-Siegel2012Intro_120-0" class="reference"><a href="#cite_note-Siegel2012Intro-120"><span class="cite-bracket">[</span>120<span class="cite-bracket">]</span></a></sup> Flexible sigmoidoscopy, however, has the best evidence for decreasing the risk of death from any cause.<sup id="cite_ref-121" class="reference"><a href="#cite_note-121"><span class="cite-bracket">[</span>121<span class="cite-bracket">]</span></a></sup> </p><p>Fecal occult blood testing (FOBT) of the stool is typically recommended every two years and can be either <a href="/wiki/Stool_guaiac_test" title="Stool guaiac test">guaiac-based</a> or <a href="/wiki/Immunochemistry" title="Immunochemistry">immunochemical</a>.<sup id="cite_ref-Lancet10_20-9" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> If abnormal FOBT results are found, participants are typically referred for a follow-up colonoscopy examination. When done once every 1–2 years, FOBT screening reduces colorectal cancer deaths by 16% and among those participating in screening, colorectal cancer deaths can be reduced up to 23%, although it has not been proven to reduce all-cause mortality.<sup id="cite_ref-122" class="reference"><a href="#cite_note-122"><span class="cite-bracket">[</span>122<span class="cite-bracket">]</span></a></sup> Immunochemical tests are accurate and do not require dietary or medication changes before testing.<sup id="cite_ref-123" class="reference"><a href="#cite_note-123"><span class="cite-bracket">[</span>123<span class="cite-bracket">]</span></a></sup> However, research in the UK has found that for these immunochemical tests, the threshold for further investigation is set at a point that may miss more than half of bowel cancer cases. The research suggests that the <a href="/wiki/NHS_England" title="NHS England">NHS England's</a> Bowel Cancer Screening Programme could make better use of the test's ability to provide the exact concentration of blood in faeces (rather than only whether it is above or below a cutoff level).<sup id="cite_ref-124" class="reference"><a href="#cite_note-124"><span class="cite-bracket">[</span>124<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Li-2021_125-0" class="reference"><a href="#cite_note-Li-2021-125"><span class="cite-bracket">[</span>125<span class="cite-bracket">]</span></a></sup> </p><p>Other options include <a href="/wiki/Virtual_colonoscopy" title="Virtual colonoscopy">virtual colonoscopy</a> and stool DNA screening testing (FIT-DNA). Virtual colonoscopy via a <a href="/wiki/CT_scan" title="CT scan">CT scan</a> appears as good as standard colonoscopy for detecting cancers and large adenomas but is expensive, associated with radiation exposure, and cannot remove any detected abnormal growths as standard colonoscopy can.<sup id="cite_ref-Lancet10_20-10" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Stool DNA screening test looks for <a href="/wiki/Biomarker" title="Biomarker">biomarkers</a> associated with colorectal cancer and precancerous lesions, including altered <a href="/wiki/DNA" title="DNA">DNA</a> and <a href="/wiki/Hemoglobin_A" title="Hemoglobin A">blood hemoglobin</a>. A positive result should be followed by <a href="/wiki/Colonoscopy" title="Colonoscopy">colonoscopy</a>. FIT-DNA has more false positives than FIT and thus results in more adverse effects.<sup id="cite_ref-USPSTF2016_10-2" class="reference"><a href="#cite_note-USPSTF2016-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> Further study is required as of 2016 to determine whether a three-year screening interval is correct.<sup id="cite_ref-USPSTF2016_10-3" class="reference"><a href="#cite_note-USPSTF2016-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Recommendations">Recommendations</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=17" title="Edit section: Recommendations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In the United States, screening is typically recommended between ages 50 and 75 years.<sup id="cite_ref-USPSTF2016_10-4" class="reference"><a href="#cite_note-USPSTF2016-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Qa2019_126-0" class="reference"><a href="#cite_note-Qa2019-126"><span class="cite-bracket">[</span>126<span class="cite-bracket">]</span></a></sup> The <a href="/wiki/American_Cancer_Society" title="American Cancer Society">American Cancer Society</a> recommends starting at the age of 45.<sup id="cite_ref-127" class="reference"><a href="#cite_note-127"><span class="cite-bracket">[</span>127<span class="cite-bracket">]</span></a></sup> For those between 76 and 85 years old, the decision to screen should be individualized.<sup id="cite_ref-USPSTF2016_10-5" class="reference"><a href="#cite_note-USPSTF2016-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> For those at high risk, screenings usually begin at around 40.<sup id="cite_ref-Lancet10_20-11" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-USPTF2008_128-0" class="reference"><a href="#cite_note-USPTF2008-128"><span class="cite-bracket">[</span>128<span class="cite-bracket">]</span></a></sup> </p><p>Several screening methods are recommended including stool-based tests every 2 years, <a href="/wiki/Sigmoidoscopy" title="Sigmoidoscopy">sigmoidoscopy</a> every 10 years with <a href="/wiki/Fecal_immunochemical_testing" class="mw-redirect" title="Fecal immunochemical testing">fecal immunochemical testing</a> every two years, and <a href="/wiki/Colonoscopy" title="Colonoscopy">colonoscopy</a> every 10 years.<sup id="cite_ref-Qa2019_126-1" class="reference"><a href="#cite_note-Qa2019-126"><span class="cite-bracket">[</span>126<span class="cite-bracket">]</span></a></sup> It is unclear which of these two methods is better.<sup id="cite_ref-Bren2014_129-0" class="reference"><a href="#cite_note-Bren2014-129"><span class="cite-bracket">[</span>129<span class="cite-bracket">]</span></a></sup> Colonoscopy may find more cancers in the first part of the colon, but is associated with greater cost and more complications.<sup id="cite_ref-Bren2014_129-1" class="reference"><a href="#cite_note-Bren2014-129"><span class="cite-bracket">[</span>129<span class="cite-bracket">]</span></a></sup> For people with average risk who have had a high-quality colonoscopy with normal results, the <a href="/wiki/American_Gastroenterological_Association" title="American Gastroenterological Association">American Gastroenterological Association</a> does not recommend any type of screening in the 10 years following the colonoscopy.<sup id="cite_ref-AGAfive_130-0" class="reference"><a href="#cite_note-AGAfive-130"><span class="cite-bracket">[</span>130<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-coloscreen_131-0" class="reference"><a href="#cite_note-coloscreen-131"><span class="cite-bracket">[</span>131<span class="cite-bracket">]</span></a></sup> For people over 75 or those with a life expectancy of less than 10 years, screening is not recommended.<sup id="cite_ref-132" class="reference"><a href="#cite_note-132"><span class="cite-bracket">[</span>132<span class="cite-bracket">]</span></a></sup> It takes about 10 years after screening for one out of a 1000 people to benefit.<sup id="cite_ref-133" class="reference"><a href="#cite_note-133"><span class="cite-bracket">[</span>133<span class="cite-bracket">]</span></a></sup> The USPSTF list seven potential strategies for screening, with the most important thing being that at least one of these strategies is appropriately used.<sup id="cite_ref-USPSTF2016_10-6" class="reference"><a href="#cite_note-USPSTF2016-10"><span class="cite-bracket">[</span>10<span class="cite-bracket">]</span></a></sup> </p><p>In Canada, among those 50 to 75 years old at normal risk, fecal immunochemical testing or FOBT is recommended every two years or sigmoidoscopy every 10 years.<sup id="cite_ref-CMAJ2016_134-0" class="reference"><a href="#cite_note-CMAJ2016-134"><span class="cite-bracket">[</span>134<span class="cite-bracket">]</span></a></sup> Colonoscopy is less preferred.<sup id="cite_ref-CMAJ2016_134-1" class="reference"><a href="#cite_note-CMAJ2016-134"><span class="cite-bracket">[</span>134<span class="cite-bracket">]</span></a></sup> </p><p>Some countries have national colorectal screening programs that offer FOBT screening for all adults within a certain age group, typically starting between ages 50 and 60. Examples of countries with organised screening include the United Kingdom,<sup id="cite_ref-135" class="reference"><a href="#cite_note-135"><span class="cite-bracket">[</span>135<span class="cite-bracket">]</span></a></sup> Australia,<sup id="cite_ref-136" class="reference"><a href="#cite_note-136"><span class="cite-bracket">[</span>136<span class="cite-bracket">]</span></a></sup> the Netherlands,<sup id="cite_ref-137" class="reference"><a href="#cite_note-137"><span class="cite-bracket">[</span>137<span class="cite-bracket">]</span></a></sup> Hong Kong, and Taiwan.<sup id="cite_ref-138" class="reference"><a href="#cite_note-138"><span class="cite-bracket">[</span>138<span class="cite-bracket">]</span></a></sup> </p><p>The UK Bowel Cancer Screening Programme aims to find warning signs in people aged 60 to 74, by recommending a faecal immunochemical test (FIT) every two years. FIT measures blood in faeces, and people with levels above a certain threshold may have bowel tissue examined for signs of cancer. Growths having cancerous potential are removed.<sup id="cite_ref-139" class="reference"><a href="#cite_note-139"><span class="cite-bracket">[</span>139<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Li-2021_125-1" class="reference"><a href="#cite_note-Li-2021-125"><span class="cite-bracket">[</span>125<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=18" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The treatment of colorectal cancer can be aimed at cure or palliation. The decision on which aim to adopt depends on various factors, including the person's health and preferences, as well as the stage of the tumor.<sup id="cite_ref-pmid21943995_140-0" class="reference"><a href="#cite_note-pmid21943995-140"><span class="cite-bracket">[</span>140<span class="cite-bracket">]</span></a></sup> Assessment in multidisciplinary teams is a critical part of determining whether the patient is suitable for surgery or not.<sup id="cite_ref-141" class="reference"><a href="#cite_note-141"><span class="cite-bracket">[</span>141<span class="cite-bracket">]</span></a></sup> When colorectal cancer is caught early, surgery can be curative. However, when it is detected at later stages (for which <a href="/wiki/Metastasis" title="Metastasis">metastases</a> are present), this is less likely and treatment is often directed at palliation, to relieve symptoms caused by the tumour and keep the person as comfortable as possible.<sup id="cite_ref-Lancet10_20-12" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Surgery">Surgery</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=19" title="Edit section: Surgery"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Diagram_showing_a_local_resection_of_an_early_stage_bowel_cancer_CRUK_068.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/e/e7/Diagram_showing_a_local_resection_of_an_early_stage_bowel_cancer_CRUK_068.svg/220px-Diagram_showing_a_local_resection_of_an_early_stage_bowel_cancer_CRUK_068.svg.png" decoding="async" width="220" height="205" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/e/e7/Diagram_showing_a_local_resection_of_an_early_stage_bowel_cancer_CRUK_068.svg/330px-Diagram_showing_a_local_resection_of_an_early_stage_bowel_cancer_CRUK_068.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/e/e7/Diagram_showing_a_local_resection_of_an_early_stage_bowel_cancer_CRUK_068.svg/440px-Diagram_showing_a_local_resection_of_an_early_stage_bowel_cancer_CRUK_068.svg.png 2x" data-file-width="375" data-file-height="350" /></a><figcaption>A diagram of a local resection of early stage colon cancer</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Diagram_showing_the_area_removed_for_a_rectal_cancer_CRUK_286.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/72/Diagram_showing_the_area_removed_for_a_rectal_cancer_CRUK_286.svg/220px-Diagram_showing_the_area_removed_for_a_rectal_cancer_CRUK_286.svg.png" decoding="async" width="220" height="243" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/72/Diagram_showing_the_area_removed_for_a_rectal_cancer_CRUK_286.svg/330px-Diagram_showing_the_area_removed_for_a_rectal_cancer_CRUK_286.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/72/Diagram_showing_the_area_removed_for_a_rectal_cancer_CRUK_286.svg/440px-Diagram_showing_the_area_removed_for_a_rectal_cancer_CRUK_286.svg.png 2x" data-file-width="375" data-file-height="415" /></a><figcaption>A diagram of local surgery for rectal cancer</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Edges_and_margins_in_intestinal_tumor.png" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/8/88/Edges_and_margins_in_intestinal_tumor.png/220px-Edges_and_margins_in_intestinal_tumor.png" decoding="async" width="220" height="219" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/8/88/Edges_and_margins_in_intestinal_tumor.png/330px-Edges_and_margins_in_intestinal_tumor.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/8/88/Edges_and_margins_in_intestinal_tumor.png/440px-Edges_and_margins_in_intestinal_tumor.png 2x" data-file-width="1120" data-file-height="1116" /></a><figcaption>Margins of a colonic resection.</figcaption></figure> <p>At an early stage, colorectal cancer may be removed during a colonoscopy using one of several techniques, including <a href="/wiki/Endoscopic_mucosal_resection" title="Endoscopic mucosal resection">endoscopic mucosal resection</a> or <a href="/wiki/Endoscopic_submucosal_dissection" title="Endoscopic submucosal dissection">endoscopic submucosal dissection</a>.<sup id="cite_ref-NCI2014PtTx_5-5" class="reference"><a href="#cite_note-NCI2014PtTx-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> Endoscopic resection is possible if there is a low possibility of lymph node metastasis and the size and location of the tumor make en bloc resection possible.<sup id="cite_ref-142" class="reference"><a href="#cite_note-142"><span class="cite-bracket">[</span>142<span class="cite-bracket">]</span></a></sup> For people with localized cancer, the preferred treatment is complete surgical removal with adequate <a href="/wiki/Resection_margin" title="Resection margin">margins</a>, with the attempt of achieving a cure. The procedure of choice is a partial <a href="/wiki/Colectomy" title="Colectomy">colectomy</a> (or proctocolectomy for rectal lesions) where the affected part of the colon or rectum is removed along with parts of its <a href="/wiki/Mesocolon" class="mw-redirect" title="Mesocolon">mesocolon</a> and <a href="/wiki/Mesenteric_arteries" title="Mesenteric arteries">blood supply</a> to facilitate removal of draining <a href="/wiki/Lymph_node" title="Lymph node">lymph nodes</a>. This can be done either by an open <a href="/wiki/Laparotomy" title="Laparotomy">laparotomy</a> or <a href="/wiki/Laparoscopic" class="mw-redirect" title="Laparoscopic">laparoscopically</a>, depending on factors related to the individual person and lesion factors.<sup id="cite_ref-Lancet10_20-13" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> The colon may then be reconnected or a person may have a <a href="/wiki/Colostomy" title="Colostomy">colostomy</a>.<sup id="cite_ref-NCI2014PtTx_5-6" class="reference"><a href="#cite_note-NCI2014PtTx-5"><span class="cite-bracket">[</span>5<span class="cite-bracket">]</span></a></sup> </p><p>If there are only a few metastases in the liver or lungs, these may also be removed. <a href="/wiki/Chemotherapy" title="Chemotherapy">Chemotherapy</a> may be used before surgery to shrink the cancer before attempting to remove it. The two most common sites of recurrence of colorectal cancer are the <a href="/wiki/Liver" title="Liver">liver</a> and <a href="/wiki/Lungs" class="mw-redirect" title="Lungs">lungs</a>.<sup id="cite_ref-Lancet10_20-14" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> For <a href="/wiki/Peritoneal_carcinomatosis" title="Peritoneal carcinomatosis">peritoneal carcinomatosis</a> <a href="/wiki/Cytoreductive_surgery" title="Cytoreductive surgery">cytoreductive surgery</a>, sometimes in combination with <a href="/wiki/Hyperthermic_intraperitoneal_chemotherapy" title="Hyperthermic intraperitoneal chemotherapy">HIPEC</a> can be used in an attempt to remove the cancer.<sup id="cite_ref-McCarthy-2012_143-0" class="reference"><a href="#cite_note-McCarthy-2012-143"><span class="cite-bracket">[</span>143<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Chemotherapy">Chemotherapy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=20" title="Edit section: Chemotherapy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In both cancer of the <a href="/wiki/Colon_(anatomy)" class="mw-redirect" title="Colon (anatomy)">colon</a> and <a href="/wiki/Rectum" title="Rectum">rectum</a>, <a href="/wiki/Chemotherapy" title="Chemotherapy">chemotherapy</a> may be used in addition to surgery in certain cases. The decision to add chemotherapy in the management of colon and rectal cancer depends on the stage of the disease.<sup id="cite_ref-Colorectal_Colon_Cancer_144-0" class="reference"><a href="#cite_note-Colorectal_Colon_Cancer-144"><span class="cite-bracket">[</span>144<span class="cite-bracket">]</span></a></sup> </p><p>In Stage I colon cancer, no chemotherapy is offered, and surgery is the definitive treatment. The role of chemotherapy in Stage II colon cancer is debatable and is usually not offered unless risk factors such as T4 tumor, undifferentiated tumor, vascular and perineural invasion, or inadequate lymph node sampling are identified.<sup id="cite_ref-145" class="reference"><a href="#cite_note-145"><span class="cite-bracket">[</span>145<span class="cite-bracket">]</span></a></sup> It is also known that the people who carry abnormalities of the mismatch repair genes do not benefit from chemotherapy. For Stage III and Stage IV colon cancer, chemotherapy is an integral part of treatment.<sup id="cite_ref-Lancet10_20-15" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p><p>If cancer has spread to the <a href="/wiki/Lymph_nodes" class="mw-redirect" title="Lymph nodes">lymph nodes</a> or distant organs, which is the case with Stage III and Stage IV colon cancer respectively, adding chemotherapy agents <a href="/wiki/Fluorouracil" title="Fluorouracil">fluorouracil</a>, <a href="/wiki/Capecitabine" title="Capecitabine">capecitabine</a> or <a href="/wiki/Oxaliplatin" title="Oxaliplatin">oxaliplatin</a> increases life expectancy. If the lymph nodes do not contain cancer, the benefits of chemotherapy are controversial. If the cancer is widely metastatic or unresectable, treatment is then <a href="/wiki/Palliative" class="mw-redirect" title="Palliative">palliative</a>. Typically in this setting, a number of different chemotherapy medications may be used.<sup id="cite_ref-Lancet10_20-16" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> Chemotherapy drugs for this condition may include <a href="/wiki/Capecitabine" title="Capecitabine">capecitabine</a>, <a href="/wiki/Fluorouracil" title="Fluorouracil">fluorouracil</a>, <a href="/wiki/Irinotecan" title="Irinotecan">irinotecan</a>, <a href="/wiki/Oxaliplatin" title="Oxaliplatin">oxaliplatin</a> and <a href="/wiki/Tegafur-Uracil" class="mw-redirect" title="Tegafur-Uracil">UFT</a>.<sup id="cite_ref-146" class="reference"><a href="#cite_note-146"><span class="cite-bracket">[</span>146<span class="cite-bracket">]</span></a></sup> The drugs capecitabine and fluorouracil are interchangeable, with capecitabine being an oral medication and fluorouracil being an intravenous medicine. Some specific <a href="/wiki/Chemotherapy_regimen" title="Chemotherapy regimen">regimens</a> used for CRC are <a href="/wiki/CAPOX" title="CAPOX">CAPOX</a>, <a href="/wiki/FOLFOX" title="FOLFOX">FOLFOX</a>, <a href="/wiki/FOLFOXIRI" title="FOLFOXIRI">FOLFOXIRI</a>, and <a href="/wiki/FOLFIRI" title="FOLFIRI">FOLFIRI</a>.<sup id="cite_ref-Fakih_147-0" class="reference"><a href="#cite_note-Fakih-147"><span class="cite-bracket">[</span>147<span class="cite-bracket">]</span></a></sup> Antiangiogenic drugs such as <a href="/wiki/Bevacizumab" title="Bevacizumab">bevacizumab</a> are often added in first line therapy.<sup id="cite_ref-l758_148-0" class="reference"><a href="#cite_note-l758-148"><span class="cite-bracket">[</span>148<span class="cite-bracket">]</span></a></sup> Another class of drugs used in the second line setting are <a href="/wiki/Epidermal_growth_factor_receptor" title="Epidermal growth factor receptor">epidermal growth factor receptor</a> inhibitors, of which the three FDA approved ones are <a href="/wiki/Aflibercept" title="Aflibercept">aflibercept</a>, <a href="/wiki/Cetuximab" title="Cetuximab">cetuximab</a> and <a href="/wiki/Panitumumab" title="Panitumumab">panitumumab</a>.<sup id="cite_ref-Shaib2013_149-0" class="reference"><a href="#cite_note-Shaib2013-149"><span class="cite-bracket">[</span>149<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-150" class="reference"><a href="#cite_note-150"><span class="cite-bracket">[</span>150<span class="cite-bracket">]</span></a></sup> </p><p>The primary difference in the approach to low-stage rectal cancer is the incorporation of radiation therapy. Often, it is used in conjunction with chemotherapy in a <a href="/wiki/Neoadjuvant" class="mw-redirect" title="Neoadjuvant">neoadjuvant</a> fashion to enable surgical resection, so that ultimately a <a href="/wiki/Colostomy" title="Colostomy">colostomy</a> is not required. However, it may not be possible in low-lying tumors, in which case, a permanent colostomy may be required. Stage IV rectal cancer is treated similarly to Stage IV colon cancer. </p><p>Stage IV colorectal cancer due to <a href="/wiki/Peritoneal_carcinomatosis" title="Peritoneal carcinomatosis">peritoneal carcinomatosis</a> can be treated using <a href="/wiki/Hyperthermic_intraperitoneal_chemotherapy" title="Hyperthermic intraperitoneal chemotherapy">HIPEC</a> combined with cytoreductive surgery, in some people.<sup id="cite_ref-151" class="reference"><a href="#cite_note-151"><span class="cite-bracket">[</span>151<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-152" class="reference"><a href="#cite_note-152"><span class="cite-bracket">[</span>152<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-153" class="reference"><a href="#cite_note-153"><span class="cite-bracket">[</span>153<span class="cite-bracket">]</span></a></sup> Also, T4 colorectal cancer can be treated with HIPEC to avoid future relapses.<sup id="cite_ref-154" class="reference"><a href="#cite_note-154"><span class="cite-bracket">[</span>154<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Radiation_therapy">Radiation therapy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=21" title="Edit section: Radiation therapy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>While a combination of <a href="/wiki/Radiation" title="Radiation">radiation</a> and chemotherapy may be useful for <a href="/wiki/Rectal_cancer" class="mw-redirect" title="Rectal cancer">rectal cancer</a>,<sup id="cite_ref-Lancet10_20-17" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> for some people requiring treatment, chemoradiotherapy can increase acute treatment-related toxicity and has not been shown to improve survival rates compared to radiotherapy alone, although it is associated with less local recurrence.<sup id="cite_ref-McCarthy-2012_143-1" class="reference"><a href="#cite_note-McCarthy-2012-143"><span class="cite-bracket">[</span>143<span class="cite-bracket">]</span></a></sup> For squamous cell carcinoma of the anal canal, chemoradiation therapy (CRT) with 5-FU and mitomycin C is preferred over radiation alone, offering improved survival outcomes but with increased risks of <a href="/wiki/Hematologic_disease" title="Hematologic disease">acute hematological toxicity</a>.<sup id="cite_ref-djae195_155-0" class="reference"><a href="#cite_note-djae195-155"><span class="cite-bracket">[</span>155<span class="cite-bracket">]</span></a></sup> </p><p>The use of radiotherapy in colon cancer is not routine due to the sensitivity of the bowels to radiation.<sup id="cite_ref-156" class="reference"><a href="#cite_note-156"><span class="cite-bracket">[</span>156<span class="cite-bracket">]</span></a></sup> Radiation therapy's side effects (and occurrence rates) include acute (27%) and late (17%) <a href="/wiki/Skin_condition" title="Skin condition">dermatological toxicities</a>, acute (14%) and late (27%) <a href="/wiki/Gastrointestinal_disease" title="Gastrointestinal disease">gastrointestinal toxicities</a>,<sup id="cite_ref-djae195_155-1" class="reference"><a href="#cite_note-djae195-155"><span class="cite-bracket">[</span>155<span class="cite-bracket">]</span></a></sup> and late <a href="/wiki/Radiation_enteropathy" title="Radiation enteropathy">pelvic radiation disease</a> (1-10%), e.g., <a href="/wiki/Radiation-induced_lumbar_plexopathy" title="Radiation-induced lumbar plexopathy">irreversible lumbosacral plexopathy</a>.<sup id="cite_ref-CCR-19-2744_157-0" class="reference"><a href="#cite_note-CCR-19-2744-157"><span class="cite-bracket">[</span>157<span class="cite-bracket">]</span></a></sup> </p><p>As with chemotherapy, radiotherapy can be used as a neoadjuvant for clinical stages T3 and T4 for rectal cancer.<sup id="cite_ref-Neoadjuvant_radiotherapy_for_rectal_158-0" class="reference"><a href="#cite_note-Neoadjuvant_radiotherapy_for_rectal-158"><span class="cite-bracket">[</span>158<span class="cite-bracket">]</span></a></sup> This results in downsizing or downstaging of the tumour, preparing it for surgical resection, and also decreases local recurrence rates.<sup id="cite_ref-Neoadjuvant_radiotherapy_for_rectal_158-1" class="reference"><a href="#cite_note-Neoadjuvant_radiotherapy_for_rectal-158"><span class="cite-bracket">[</span>158<span class="cite-bracket">]</span></a></sup> For locally advanced rectal cancer, neoadjuvant chemoradiotherapy has become the standard treatment.<sup id="cite_ref-159" class="reference"><a href="#cite_note-159"><span class="cite-bracket">[</span>159<span class="cite-bracket">]</span></a></sup> Additionally, when surgery is not possible radiation therapy has been suggested to be an effective treatment against CRC pulmonary metastases, which are developed by 10-15% of people with CRC.<sup id="cite_ref-160" class="reference"><a href="#cite_note-160"><span class="cite-bracket">[</span>160<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Immunotherapy">Immunotherapy</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=22" title="Edit section: Immunotherapy"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Immunotherapy" title="Immunotherapy">Immunotherapy</a> with immune checkpoint inhibitors is useful for a type of colorectal cancer with <a href="/wiki/Mismatch_repair_deficiency" class="mw-redirect" title="Mismatch repair deficiency">mismatch repair deficiency</a> and <a href="/wiki/Microsatellite_instability" title="Microsatellite instability">microsatellite instability</a>.<sup id="cite_ref-Bo2017_161-0" class="reference"><a href="#cite_note-Bo2017-161"><span class="cite-bracket">[</span>161<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Nic2017_162-0" class="reference"><a href="#cite_note-Nic2017-162"><span class="cite-bracket">[</span>162<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Borras2023_163-0" class="reference"><a href="#cite_note-Borras2023-163"><span class="cite-bracket">[</span>163<span class="cite-bracket">]</span></a></sup> <a href="/wiki/Pembrolizumab" title="Pembrolizumab">Pembrolizumab</a> is approved for advanced CRC tumours that are MMR deficient and have failed usual treatments.<sup id="cite_ref-164" class="reference"><a href="#cite_note-164"><span class="cite-bracket">[</span>164<span class="cite-bracket">]</span></a></sup> Most people who do improve, however, still worsen after months or years.<sup id="cite_ref-Nic2017_162-1" class="reference"><a href="#cite_note-Nic2017-162"><span class="cite-bracket">[</span>162<span class="cite-bracket">]</span></a></sup> </p><p>On the other hand, in a prospective phase 2 study published in June 2022 in The New England Journal of Medicine, 12 patients with Deficient Mismatch Repair (dMMR) stage II or III rectal adenocarcinoma were administered single-agent <a href="/wiki/Dostarlimab" title="Dostarlimab">dostarlimab</a>, an anti–PD-1 monoclonal antibody, every three weeks for six months. After a median follow-up of 12 months (range, 6 to 25 months), all 12 patients had a complete clinical response with no evidence of tumor on MRI, 18F-fluorodeoxyglucose–positron-emission tomography, endoscopic evaluation, digital rectal examination, or biopsy. Moreover, no patient in the trial needed chemoradiotherapy or surgery, and no patient reported adverse events of grade 3 or higher. However, although the results of this study are promising, the study is small and has uncertainties about long-term outcomes.<sup id="cite_ref-dostarlimab_2022_165-0" class="reference"><a href="#cite_note-dostarlimab_2022-165"><span class="cite-bracket">[</span>165<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Palliative_care">Palliative care</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=23" title="Edit section: Palliative care"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Palliative_care" title="Palliative care">Palliative care</a> can be used at the same time as the cancer treatment and is recommended for any person who has advanced colon cancer or who has significant symptoms.<sup id="cite_ref-166" class="reference"><a href="#cite_note-166"><span class="cite-bracket">[</span>166<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-167" class="reference"><a href="#cite_note-167"><span class="cite-bracket">[</span>167<span class="cite-bracket">]</span></a></sup> Involvement of palliative care may be beneficial to improve the quality of life for both the person and his or her family, by improving symptoms, anxiety and preventing admissions to the hospital.<sup id="cite_ref-168" class="reference"><a href="#cite_note-168"><span class="cite-bracket">[</span>168<span class="cite-bracket">]</span></a></sup> </p><p>In people with incurable colorectal cancer, palliative care can consist of procedures that relieve symptoms or complications from the cancer but do not attempt to cure the underlying cancer, thereby improving <a href="/wiki/Quality_of_life" title="Quality of life">quality of life</a>. Surgical options may include non-curative surgical removal of some of the cancer tissue, bypassing part of the intestines, or stent placement. These procedures can be considered to improve symptoms and reduce complications such as bleeding from the tumor, abdominal pain, and intestinal obstruction.<sup id="cite_ref-169" class="reference"><a href="#cite_note-169"><span class="cite-bracket">[</span>169<span class="cite-bracket">]</span></a></sup> Non-operative methods of symptomatic treatment include radiation therapy to decrease tumor size as well as pain medications.<sup id="cite_ref-170" class="reference"><a href="#cite_note-170"><span class="cite-bracket">[</span>170<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Psychosocial_Intervention">Psychosocial Intervention</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=24" title="Edit section: Psychosocial Intervention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In addition to medical intervention, a variety of psychosocial interventions have been implemented to address psychosocial concerns in the context of colorectal cancer.<sup id="cite_ref-Son-2018_171-0" class="reference"><a href="#cite_note-Son-2018-171"><span class="cite-bracket">[</span>171<span class="cite-bracket">]</span></a></sup> Depression and anxiety are highly prevalent in patients diagnosed with CRC, therefore psychosocial interventions can help alleviate psychological distress.<sup id="cite_ref-Peng-2019_172-0" class="reference"><a href="#cite_note-Peng-2019-172"><span class="cite-bracket">[</span>172<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-auto1_173-0" class="reference"><a href="#cite_note-auto1-173"><span class="cite-bracket">[</span>173<span class="cite-bracket">]</span></a></sup> Many patients continue to experience symptoms of anxiety and depression following treatment, regardless of treatment outcome.<sup id="cite_ref-Peng-2019_172-1" class="reference"><a href="#cite_note-Peng-2019-172"><span class="cite-bracket">[</span>172<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-174" class="reference"><a href="#cite_note-174"><span class="cite-bracket">[</span>174<span class="cite-bracket">]</span></a></sup> Societal stigmas associated with colorectal cancer present further psychosocial challenges for CRC patients and their families.<sup id="cite_ref-Reynolds-2013_175-0" class="reference"><a href="#cite_note-Reynolds-2013-175"><span class="cite-bracket">[</span>175<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Phelan-2013a_176-0" class="reference"><a href="#cite_note-Phelan-2013a-176"><span class="cite-bracket">[</span>176<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Depression_and_Anxiety">Depression and Anxiety</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=25" title="Edit section: Depression and Anxiety"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Colorectal cancer patients have a 51% higher risk of experiencing depression than individuals without the disease.<sup id="cite_ref-auto1_173-1" class="reference"><a href="#cite_note-auto1-173"><span class="cite-bracket">[</span>173<span class="cite-bracket">]</span></a></sup> Additionally, CRC patients are at high risk of experiencing severe anxiety, low self-esteem, poor self-concept, and social anxiety.<sup id="cite_ref-Peng-2019_172-2" class="reference"><a href="#cite_note-Peng-2019-172"><span class="cite-bracket">[</span>172<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-auto2_177-0" class="reference"><a href="#cite_note-auto2-177"><span class="cite-bracket">[</span>177<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Post-Treatment_Distress">Post-Treatment Distress</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=26" title="Edit section: Post-Treatment Distress"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Regardless of treatment outcome, many CRC patients experience ongoing symptoms of anxiety, depression, and distress.<sup id="cite_ref-Peng-2019_172-3" class="reference"><a href="#cite_note-Peng-2019-172"><span class="cite-bracket">[</span>172<span class="cite-bracket">]</span></a></sup> </p><p>Survivorship of CRC can involve significant lifestyle adjustments.<sup id="cite_ref-Phelan-2013a_176-1" class="reference"><a href="#cite_note-Phelan-2013a-176"><span class="cite-bracket">[</span>176<span class="cite-bracket">]</span></a></sup> Postoperative afflictions may include stomas, bowel issues, incontinence, odor, and changes to sexual functioning.<sup id="cite_ref-Phelan-2013a_176-2" class="reference"><a href="#cite_note-Phelan-2013a-176"><span class="cite-bracket">[</span>176<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-auto2_177-1" class="reference"><a href="#cite_note-auto2-177"><span class="cite-bracket">[</span>177<span class="cite-bracket">]</span></a></sup> These changes can result in distorted body image, social anxiety, depression, and distress—all of which contribute to a poorer quality of life.<sup id="cite_ref-Phelan-2013a_176-3" class="reference"><a href="#cite_note-Phelan-2013a-176"><span class="cite-bracket">[</span>176<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-178" class="reference"><a href="#cite_note-178"><span class="cite-bracket">[</span>178<span class="cite-bracket">]</span></a></sup> </p><p>Colorectal cancer is the second leading cause of cancer-related death worldwide.<sup id="cite_ref-auto_179-0" class="reference"><a href="#cite_note-auto-179"><span class="cite-bracket">[</span>179<span class="cite-bracket">]</span></a></sup> Transitioning into palliative care and contending with mortality can be a deeply distressing experience for a CRC patient and their loved ones. </p> <div class="mw-heading mw-heading4"><h4 id="Stigma">Stigma</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=27" title="Edit section: Stigma"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Colorectal cancer is highly stigmatized and can elicit feelings of disgust from patients, healthcare professionals, families, intimate partners, and the general public.<sup id="cite_ref-Reynolds-2013_175-1" class="reference"><a href="#cite_note-Reynolds-2013-175"><span class="cite-bracket">[</span>175<span class="cite-bracket">]</span></a></sup> Patients with stomas are especially vulnerable to stigmatization due to unavoidable odors, gas, and unpleasant noises from stoma bags.<sup id="cite_ref-Reynolds-2013_175-2" class="reference"><a href="#cite_note-Reynolds-2013-175"><span class="cite-bracket">[</span>175<span class="cite-bracket">]</span></a></sup> Additionally, associated CRC risk factors like poor diet, alcohol consumption, and lack of physical activity prompt negative assumptions of blame and personal responsibility onto CRC patients.<sup id="cite_ref-Phelan-2013a_176-4" class="reference"><a href="#cite_note-Phelan-2013a-176"><span class="cite-bracket">[</span>176<span class="cite-bracket">]</span></a></sup> Judgement from others along with internalized self-blame and embarrassment can negatively affect self-esteem, sociability, and quality of life.<sup id="cite_ref-Phelan-2013a_176-5" class="reference"><a href="#cite_note-Phelan-2013a-176"><span class="cite-bracket">[</span>176<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading4"><h4 id="Methods_of_Intervention">Methods of Intervention</h4><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=28" title="Edit section: Methods of Intervention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Face-to-face interventions such as clinician-patient talk therapy, body-mind-spirit practices, and support group sessions have been identified as most effective in reducing anxiety and depression in CRC patients.<sup id="cite_ref-Son-2018_171-1" class="reference"><a href="#cite_note-Son-2018-171"><span class="cite-bracket">[</span>171<span class="cite-bracket">]</span></a></sup> Additionally, journaling exercises and over-the-phone talk therapy sessions have been implemented.<sup id="cite_ref-Son-2018_171-2" class="reference"><a href="#cite_note-Son-2018-171"><span class="cite-bracket">[</span>171<span class="cite-bracket">]</span></a></sup> Though deemed less effective, these non-face-to-face interventions are economically inclusive and have been found to reduce both depression and anxiety in CRC patients.<sup id="cite_ref-Son-2018_171-3" class="reference"><a href="#cite_note-Son-2018-171"><span class="cite-bracket">[</span>171<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Follow-up">Follow-up</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=29" title="Edit section: Follow-up"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The U.S. <a href="/wiki/National_Comprehensive_Cancer_Network" title="National Comprehensive Cancer Network">National Comprehensive Cancer Network</a> and <a href="/wiki/American_Society_of_Clinical_Oncology" title="American Society of Clinical Oncology">American Society of Clinical Oncology</a> provide guidelines for the follow-up of colon cancer.<sup id="cite_ref-NCCNguidelines_180-0" class="reference"><a href="#cite_note-NCCNguidelines-180"><span class="cite-bracket">[</span>180<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid16260687_181-0" class="reference"><a href="#cite_note-pmid16260687-181"><span class="cite-bracket">[</span>181<span class="cite-bracket">]</span></a></sup> A <a href="/wiki/Medical_history" title="Medical history">medical history</a> and <a href="/wiki/Physical_examination" title="Physical examination">physical examination</a> are recommended every 3 to 6 months for 2 years, then every 6 months for 5 years. <a href="/wiki/Carcinoembryonic_antigen" title="Carcinoembryonic antigen">Carcinoembryonic antigen</a> blood level measurements follow the same timing but are only advised for people with T2 or greater lesions who are candidates for intervention. A <a href="/wiki/Computed_tomography" class="mw-redirect" title="Computed tomography">CT-scan</a> of the chest, abdomen, and pelvis can be considered annually for the first 3 years for people who are at high risk of recurrence (for example, those who had poorly differentiated tumors or venous or lymphatic invasion) and are candidates for curative surgery (with the aim to cure). A <a href="/wiki/Colonoscopy" title="Colonoscopy">colonoscopy</a> can be done after 1 year, except if it could not be done during the initial staging because of an obstructing mass, in which case it should be performed after 3 to 6 months. If a villous polyp, a polyp >1 centimeter or high-grade dysplasia is found, it can be repeated after 3 years, then every 5 years. For other abnormalities, the colonoscopy can be repeated after 1 year.<sup id="cite_ref-Colorectal_Colon_Cancer_144-1" class="reference"><a href="#cite_note-Colorectal_Colon_Cancer-144"><span class="cite-bracket">[</span>144<span class="cite-bracket">]</span></a></sup> </p><p>Routine <a href="/wiki/Positron_emission_tomography" title="Positron emission tomography">PET</a> or <a href="/wiki/Medical_ultrasonography" class="mw-redirect" title="Medical ultrasonography">ultrasound scanning</a>, <a href="/wiki/Chest_X-ray" class="mw-redirect" title="Chest X-ray">chest X-rays</a>, <a href="/wiki/Complete_blood_count" title="Complete blood count">complete blood count</a> or <a href="/wiki/Liver_function_tests" title="Liver function tests">liver function tests</a> are not recommended.<sup id="cite_ref-NCCNguidelines_180-1" class="reference"><a href="#cite_note-NCCNguidelines-180"><span class="cite-bracket">[</span>180<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-pmid16260687_181-1" class="reference"><a href="#cite_note-pmid16260687-181"><span class="cite-bracket">[</span>181<span class="cite-bracket">]</span></a></sup> </p><p>For people who have undergone curative surgery or adjuvant therapy (or both) to treat non-metastatic colorectal cancer, intense surveillance and close follow-up have not been shown to provide additional survival benefits.<sup id="cite_ref-182" class="reference"><a href="#cite_note-182"><span class="cite-bracket">[</span>182<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Exercise">Exercise</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=30" title="Edit section: Exercise"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Exercise may be recommended in the future as secondary therapy for cancer survivors. In epidemiological studies, exercise may decrease colorectal cancer-specific mortality and all-cause mortality. Results for the specific amounts of exercise needed to observe a benefit were conflicting. These differences may reflect differences in tumour biology and the expression of biomarkers. People with tumors that lacked <a href="/wiki/CTNNB1" class="mw-redirect" title="CTNNB1">CTNNB1</a> expression (β-catenin), involved in <a href="/wiki/Wnt_signalling_pathway" class="mw-redirect" title="Wnt signalling pathway">Wnt signalling pathway</a>, required more than 18 <a href="/wiki/Metabolic_equivalent" class="mw-redirect" title="Metabolic equivalent">Metabolic equivalent</a> (MET) hours per week, a measure of exercise, to observe a reduction in colorectal cancer mortality. The mechanism of how exercise benefits survival may be involved in immune surveillance and inflammation pathways. In clinical studies, a pro-inflammatory response was found in people with stage II-III colorectal cancer who underwent 2 weeks of moderate exercise after completing their primary therapy. Oxidative balance may be another possible mechanism for the benefits observed. A significant decrease in 8-oxo-dG was found in the urine of people who underwent 2 weeks of moderate exercise after primary therapy. Other possible mechanisms may involve metabolic hormones and sex-steroid hormones, although these pathways may be involved in other types of cancers.<sup id="cite_ref-183" class="reference"><a href="#cite_note-183"><span class="cite-bracket">[</span>183<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Ballard-Barbash2012_184-0" class="reference"><a href="#cite_note-Ballard-Barbash2012-184"><span class="cite-bracket">[</span>184<span class="cite-bracket">]</span></a></sup> </p><p>Another potential biomarker may be <a href="/wiki/P27_(gene)" class="mw-redirect" title="P27 (gene)">p27</a>. Survivors with tumors that expressed p27 and performed greater and equal to 18 MET hours per week were found to have reduced colorectal cancer mortality survival compared to those with less than 18 MET hours per week. Survivors without p27 expression who exercised were shown to have worse outcomes. The constitutive activation of <a href="/wiki/PI3K/AKT/mTOR_pathway" title="PI3K/AKT/mTOR pathway">PI3K/AKT/mTOR pathway</a> may explain the loss of p27 and excess energy balance may up-regulate p27 to stop cancer cells from dividing.<sup id="cite_ref-Ballard-Barbash2012_184-1" class="reference"><a href="#cite_note-Ballard-Barbash2012-184"><span class="cite-bracket">[</span>184<span class="cite-bracket">]</span></a></sup> </p><p>Physical activity provides benefits to people with non-advanced colorectal cancer. Improvements in aerobic fitness, cancer-related fatigue and health-related quality of life have been reported in the short term.<sup id="cite_ref-Physical_activity_interventions_for_185-0" class="reference"><a href="#cite_note-Physical_activity_interventions_for-185"><span class="cite-bracket">[</span>185<span class="cite-bracket">]</span></a></sup> However, these improvements were not observed at the level of disease-related mental health, such as anxiety and depression.<sup id="cite_ref-Physical_activity_interventions_for_185-1" class="reference"><a href="#cite_note-Physical_activity_interventions_for-185"><span class="cite-bracket">[</span>185<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prognosis">Prognosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=31" title="Edit section: Prognosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Fewer than 600 genes are linked to outcomes in colorectal cancer.<sup id="cite_ref-Uh2017_52-1" class="reference"><a href="#cite_note-Uh2017-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> These include both unfavorable genes, where high expression is related to poor outcome, for example the <a href="/wiki/HSPA1A" title="HSPA1A">heat shock 70 kDa protein 1 (HSPA1A)</a>, and favorable genes where high expression is associated with better survival, for example the <a href="/wiki/RBM3" title="RBM3">putative RNA-binding protein 3 (RBM3)</a>.<sup id="cite_ref-Uh2017_52-2" class="reference"><a href="#cite_note-Uh2017-52"><span class="cite-bracket">[</span>52<span class="cite-bracket">]</span></a></sup> The prognosis is also correlated with a poor fidelity of the pre-mRNA splicing apparatus, and thus a high number of deviating alternative splicing.<sup id="cite_ref-Stromme_186-0" class="reference"><a href="#cite_note-Stromme-186"><span class="cite-bracket">[</span>186<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Recurrence_rates">Recurrence rates</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=32" title="Edit section: Recurrence rates"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Cancer_recurrence#Rectal_cancer" class="mw-redirect" title="Cancer recurrence">Cancer recurrence § Rectal cancer</a></div> <p>The average five-year recurrence rate in people with <i>colon cancer</i> where surgery is successful is 5% for <a href="/wiki/Cancer_staging" title="Cancer staging">stage</a> I cancers, 12% in stage II, and 33% in stage III. However, depending on the number of risk factors it ranges from 9–22% in stage II and 17–44% in stage III.<sup id="cite_ref-187" class="reference"><a href="#cite_note-187"><span class="cite-bracket">[</span>187<span class="cite-bracket">]</span></a></sup> The average five-year recurrence rate in people with <i>rectal cancer</i> where surgery is successful is 9% for stage 0 <a href="/wiki/Neoadjuvant_therapy" title="Neoadjuvant therapy">(after pre-treatment)</a> cancers, 8% for stage I cancers, 18% in stage II and 34% in stage III. Depending on the number of risk factors (0-2) the risk for distant metastasis in <i>rectal cancer</i> ranges from 4-11% in stage 0, 6-12% in stage I, 11-28% in stage II, and 15-43% in stage III.<sup id="cite_ref-:0_188-0" class="reference"><a href="#cite_note-:0-188"><span class="cite-bracket">[</span>188<span class="cite-bracket">]</span></a></sup> </p><p>The recurrence rates have decreased over the past decades as a result of improvements in the colorectal cancer management.<sup id="cite_ref-189" class="reference"><a href="#cite_note-189"><span class="cite-bracket">[</span>189<span class="cite-bracket">]</span></a></sup> The risk of recurrence after five years of surveillance remain very low.<sup id="cite_ref-190" class="reference"><a href="#cite_note-190"><span class="cite-bracket">[</span>190<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Survival_rates">Survival rates</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=33" title="Edit section: Survival rates"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In Europe, the <a href="/wiki/Five-year_survival_rate" title="Five-year survival rate">five-year survival rate</a> for colorectal cancer is less than 60%. In the <a href="/wiki/Developed_world" class="mw-redirect" title="Developed world">developed world</a> about a third of people who get the disease die from it.<sup id="cite_ref-Lancet10_20-18" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> </p><p>Survival is directly related to detection and the type of cancer involved, but overall is poor for symptomatic cancers, as they are typically quite advanced. Survival rates for early-stage detection are about five times that of late-stage cancers. People with a tumor that has not breached the <a href="/wiki/Muscularis_mucosa" class="mw-redirect" title="Muscularis mucosa">muscularis mucosa</a> (TNM stage Tis, N0, M0) have a five-year survival rate of 100%, while those with invasive cancer of T1 (within the submucosal layer) or T2 (within the muscular layer) have an average five-year survival rate of approximately 90%. Those with a more invasive tumor yet without node involvement (T3-4, N0, M0) have an average five-year survival rate of approximately 70%. People with positive regional lymph nodes (any T, N1-3, M0) have an average five-year survival rate of approximately 40%, while those with distant metastases (any T, any N, M1) have a poor prognosis and the five-year survival ranges from <5 percent to 31 percent.<sup id="cite_ref-pmid20332485_191-0" class="reference"><a href="#cite_note-pmid20332485-191"><span class="cite-bracket">[</span>191<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-agabegi2nd_192-0" class="reference"><a href="#cite_note-agabegi2nd-192"><span class="cite-bracket">[</span>192<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-193" class="reference"><a href="#cite_note-193"><span class="cite-bracket">[</span>193<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-194" class="reference"><a href="#cite_note-194"><span class="cite-bracket">[</span>194<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-195" class="reference"><a href="#cite_note-195"><span class="cite-bracket">[</span>195<span class="cite-bracket">]</span></a></sup> </p><p><a href="/wiki/Survival_rate" title="Survival rate">Five-year overall survival (OS)</a> in rectal cancer after modern <a href="/wiki/Neoadjuvant_therapy" title="Neoadjuvant therapy">preoperative treatment</a> and surgery was 90% for stage 0, 86% for stage I, 78% for stage II, and 67% for stage III according to a nationwide, population-based study.<sup id="cite_ref-:0_188-1" class="reference"><a href="#cite_note-:0-188"><span class="cite-bracket">[</span>188<span class="cite-bracket">]</span></a></sup> </p><p>Whilst the impact of colorectal cancer on those who survive varies greatly there will often be a need to adapt to both physical and psychological outcomes of the illness and its treatment.<sup id="cite_ref-196" class="reference"><a href="#cite_note-196"><span class="cite-bracket">[</span>196<span class="cite-bracket">]</span></a></sup> For example, it is common for people to experience incontinence,<sup id="cite_ref-197" class="reference"><a href="#cite_note-197"><span class="cite-bracket">[</span>197<span class="cite-bracket">]</span></a></sup> sexual dysfunction,<sup id="cite_ref-198" class="reference"><a href="#cite_note-198"><span class="cite-bracket">[</span>198<span class="cite-bracket">]</span></a></sup> problems with stoma care<sup id="cite_ref-199" class="reference"><a href="#cite_note-199"><span class="cite-bracket">[</span>199<span class="cite-bracket">]</span></a></sup> and fear of cancer recurrence<sup id="cite_ref-200" class="reference"><a href="#cite_note-200"><span class="cite-bracket">[</span>200<span class="cite-bracket">]</span></a></sup> after primary treatment has concluded. </p><p>A qualitative systematic review published in 2021 highlighted that there are three main factors influencing adaptation to living with and beyond colorectal cancer: support mechanisms, severity of late effects of treatment, and psychosocial adjustment. Therefore, people must be offered appropriate support to help them better adapt to life following treatment.<sup id="cite_ref-201" class="reference"><a href="#cite_note-201"><span class="cite-bracket">[</span>201<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=34" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Colon_and_rectum_cancers_world_map-Deaths_per_million_persons-WHO2012.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/4/4a/Colon_and_rectum_cancers_world_map-Deaths_per_million_persons-WHO2012.svg/290px-Colon_and_rectum_cancers_world_map-Deaths_per_million_persons-WHO2012.svg.png" decoding="async" width="290" height="128" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/4/4a/Colon_and_rectum_cancers_world_map-Deaths_per_million_persons-WHO2012.svg/435px-Colon_and_rectum_cancers_world_map-Deaths_per_million_persons-WHO2012.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/4/4a/Colon_and_rectum_cancers_world_map-Deaths_per_million_persons-WHO2012.svg/580px-Colon_and_rectum_cancers_world_map-Deaths_per_million_persons-WHO2012.svg.png 2x" data-file-width="940" data-file-height="415" /></a><figcaption>Colon and rectum cancer deaths per million persons in 2012 <style data-mw-deduplicate="TemplateStyles:r1184024115">.mw-parser-output .div-col{margin-top:0.3em;column-width:30em}.mw-parser-output .div-col-small{font-size:90%}.mw-parser-output .div-col-rules{column-rule:1px solid #aaa}.mw-parser-output .div-col dl,.mw-parser-output .div-col ol,.mw-parser-output .div-col ul{margin-top:0}.mw-parser-output .div-col li,.mw-parser-output .div-col dd{page-break-inside:avoid;break-inside:avoid-column}</style><div class="div-col div-col-small" style="column-width: 10em;"><style data-mw-deduplicate="TemplateStyles:r981673959">.mw-parser-output .legend{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .legend-color{display:inline-block;min-width:1.25em;height:1.25em;line-height:1.25;margin:1px 0;text-align:center;border:1px solid black;background-color:transparent;color:black}.mw-parser-output .legend-text{}</style><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffff20; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 3–17</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffe820; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 18–21</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffd820; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 22–27</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffc020; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 28–36</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ffa020; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 37–54</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#ff9a20; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 55–77</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#f08015; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 78–162</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#e06815; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 163–244</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#d85010; color:black;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 245–329</div><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r981673959"><div class="legend"><span class="legend-color mw-no-invert" style="background-color:#d02010; color:white;-webkit-print-color-adjust: exact; print-color-adjust: exact;"> </span> 330–533</div></div></figcaption></figure> <p>Globally more than 1 million people get colorectal cancer every year<sup id="cite_ref-Lancet10_20-19" class="reference"><a href="#cite_note-Lancet10-20"><span class="cite-bracket">[</span>20<span class="cite-bracket">]</span></a></sup> resulting in about 715,000 deaths as of 2010 up from 490,000 in 1990.<sup id="cite_ref-202" class="reference"><a href="#cite_note-202"><span class="cite-bracket">[</span>202<span class="cite-bracket">]</span></a></sup> </p><p>As of 2012<sup class="plainlinks noexcerpt noprint asof-tag update" style="display:none;"><a class="external text" href="https://en.wikipedia.org/w/index.php?title=Colorectal_cancer&action=edit">[update]</a></sup>, it is the second most common cause of cancer in women (9.2% of diagnoses) and the third most common in men (10.0%)<sup id="cite_ref-WCR2014Epi_14-1" class="reference"><a href="#cite_note-WCR2014Epi-14"><span class="cite-bracket">[</span>14<span class="cite-bracket">]</span></a></sup><sup class="reference nowrap"><span title="Page / location: 16">: 16 </span></sup> with it being the fourth most common cause of cancer death after <a href="/wiki/Lung_cancer" title="Lung cancer">lung</a>, <a href="/wiki/Stomach_cancer" title="Stomach cancer">stomach</a>, and <a href="/wiki/Liver_cancer" title="Liver cancer">liver cancer</a>.<sup id="cite_ref-WHO_203-0" class="reference"><a href="#cite_note-WHO-203"><span class="cite-bracket">[</span>203<span class="cite-bracket">]</span></a></sup> It is more common in developed than developing countries.<sup id="cite_ref-pmid20952724_204-0" class="reference"><a href="#cite_note-pmid20952724-204"><span class="cite-bracket">[</span>204<span class="cite-bracket">]</span></a></sup> Global incidence varies 10-fold, with highest rates in Australia, New Zealand, Europe and the US and lowest rates in Africa and South-Central Asia.<sup id="cite_ref-GLOBOCAN_205-0" class="reference"><a href="#cite_note-GLOBOCAN-205"><span class="cite-bracket">[</span>205<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="United_States">United States</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=35" title="Edit section: United States"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In 2022, the incidence of colorectal cancer in the United States was anticipated to be about 151,000 adults, including over 106,000 new cases of colon cancer (some 54,000 men and 52,000 women) and about 45,000 new cases of rectal cancer.<sup id="cite_ref-asco_206-0" class="reference"><a href="#cite_note-asco-206"><span class="cite-bracket">[</span>206<span class="cite-bracket">]</span></a></sup> Since the 1980s, the incidence of colorectal cancer decreased, dropping by about 2% annually from 2014 to 2018 in adults aged 50 and older, due mainly to improved screening.<sup id="cite_ref-asco_206-1" class="reference"><a href="#cite_note-asco-206"><span class="cite-bracket">[</span>206<span class="cite-bracket">]</span></a></sup> However, the incidence of colorectal cancer has increased in individuals aged 25 to 50. In early 2023, the American Cancer Society (ACS) reported that 20% of diagnoses (of colon cancer) in 2019 were in patients under age 55, which is about double the rate in 1995, and rates of advanced disease increased by about 3% annually in people younger than 50. It predicted that, in 2023, an estimated 19,550 diagnoses and 3,750 deaths would be in people younger than 50.<sup id="cite_ref-207" class="reference"><a href="#cite_note-207"><span class="cite-bracket">[</span>207<span class="cite-bracket">]</span></a></sup> Colorectal cancer also disproportionately affects the Black community, where the rates are the highest of any racial/ethnic group in the US. African Americans are about 20% more likely to get colorectal cancer and about 40% more likely to die from it than most other groups. Black Americans often experience greater obstacles to cancer prevention, detection, treatment, and survival, including systemic racial disparities that are complex and go beyond the obvious connection to cancer. </p> <div class="mw-heading mw-heading3"><h3 id="United_Kingdom">United Kingdom</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=36" title="Edit section: United Kingdom"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In the UK about 41,000 people a year get colon cancer making it the fourth most common type.<sup id="cite_ref-208" class="reference"><a href="#cite_note-208"><span class="cite-bracket">[</span>208<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Australia">Australia</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=37" title="Edit section: Australia"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>One in 19 men and one in 28 women in Australia will develop colorectal cancer before the age of 75; one in 10 men and one in 15 women will develop it by 85 years of age.<sup id="cite_ref-209" class="reference"><a href="#cite_note-209"><span class="cite-bracket">[</span>209<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Papua_New_Guinea">Papua New Guinea</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=38" title="Edit section: Papua New Guinea"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In <a href="/wiki/Papua_New_Guinea" title="Papua New Guinea">Papua New Guinea</a> and other Pacific Island States including the <a href="/wiki/Solomon_Islands" title="Solomon Islands">Solomon Islands</a>, colorectal cancer is a very rare cancer compared to lung, stomach, liver, or breast cancer. It is estimated that 8 in 100,000 people are likely to develop colorectal cancer every year, while 24 in 100,000 women are likely to develop breast cancer.<sup id="cite_ref-210" class="reference"><a href="#cite_note-210"><span class="cite-bracket">[</span>210<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Early-onset_colorectal_cancer_(EOCC)"><span id="Early-onset_colorectal_cancer_.28EOCC.29"></span>Early-onset colorectal cancer (EOCC)</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=39" title="Edit section: Early-onset colorectal cancer (EOCC)"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A diagnosis of colorectal cancer in patients under 50 years of age is referred to as early-onset colorectal cancer (EOCC).<sup id="cite_ref-auto_179-1" class="reference"><a href="#cite_note-auto-179"><span class="cite-bracket">[</span>179<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Puzzono-2021a_211-0" class="reference"><a href="#cite_note-Puzzono-2021a-211"><span class="cite-bracket">[</span>211<span class="cite-bracket">]</span></a></sup> Instances of EOCC have increased over the last decade, specifically in patient populations aged 20 to 40 years old throughout North America, Europe, Australia, and China.<sup id="cite_ref-Puzzono-2021a_211-1" class="reference"><a href="#cite_note-Puzzono-2021a-211"><span class="cite-bracket">[</span>211<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Vuik-2019_212-0" class="reference"><a href="#cite_note-Vuik-2019-212"><span class="cite-bracket">[</span>212<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Incidence_by_age">Incidence by age</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=40" title="Edit section: Incidence by age"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The incidence of colorectal cancer in younger populations has increased over the last decade.<sup id="cite_ref-auto_179-2" class="reference"><a href="#cite_note-auto-179"><span class="cite-bracket">[</span>179<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Puzzono-2021a_211-2" class="reference"><a href="#cite_note-Puzzono-2021a-211"><span class="cite-bracket">[</span>211<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Vuik-2019_212-1" class="reference"><a href="#cite_note-Vuik-2019-212"><span class="cite-bracket">[</span>212<span class="cite-bracket">]</span></a></sup> While advancements in the diagnostic procedure may have some impact, reduced likelihood of screening among these populations suggests detection bias is not a major contributor to this trend. It is more likely that cohort effects are contributing.<sup id="cite_ref-Vuik-2019_212-2" class="reference"><a href="#cite_note-Vuik-2019-212"><span class="cite-bracket">[</span>212<span class="cite-bracket">]</span></a></sup> </p><p>The population experiencing the greatest rise in EOCC cases are men and women aged 20 to 29 years old, with incidence increasing by 7.9% per year between 2004 and 2016.<sup id="cite_ref-Vuik-2019_212-3" class="reference"><a href="#cite_note-Vuik-2019-212"><span class="cite-bracket">[</span>212<span class="cite-bracket">]</span></a></sup> Similarly, though less severe, men and women aged 30 to 39 experienced an increase in cases at a rate of 3.4% per year during that same period. Despite these increases, the mortality rate for colorectal cancer has remained the same.<sup id="cite_ref-Vuik-2019_212-4" class="reference"><a href="#cite_note-Vuik-2019-212"><span class="cite-bracket">[</span>212<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Risk_factors">Risk factors</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=41" title="Edit section: Risk factors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Risk factors associated with EOCC are akin to those of all colorectal cancer cases.<sup id="cite_ref-Puzzono-2021a_211-3" class="reference"><a href="#cite_note-Puzzono-2021a-211"><span class="cite-bracket">[</span>211<span class="cite-bracket">]</span></a></sup> Observed cohort effects are likely the product of generational shifts in lifestyle and environmental factors.<sup id="cite_ref-auto_179-3" class="reference"><a href="#cite_note-auto-179"><span class="cite-bracket">[</span>179<span class="cite-bracket">]</span></a></sup><sup id="cite_ref-Puzzono-2021a_211-4" class="reference"><a href="#cite_note-Puzzono-2021a-211"><span class="cite-bracket">[</span>211<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Preventative_screening">Preventative screening</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=42" title="Edit section: Preventative screening"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In 2018, the American Cancer Society modified their previous screening guideline for colorectal cancer from age 50 down to age 45 following the recognition of increasing cases of EOCC.<sup id="cite_ref-Vuik-2019_212-5" class="reference"><a href="#cite_note-Vuik-2019-212"><span class="cite-bracket">[</span>212<span class="cite-bracket">]</span></a></sup> Individuals under the age of 60 have been identified as most susceptible to non-participation in colorectal cancer screening.<sup id="cite_ref-213" class="reference"><a href="#cite_note-213"><span class="cite-bracket">[</span>213<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=43" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Expand_section plainlinks metadata ambox mbox-small-left ambox-content" role="presentation"><tbody><tr><td class="mbox-image"><span typeof="mw:File"><a href="/wiki/File:Wiki_letter_w_cropped.svg" class="mw-file-description"><img alt="[icon]" src="//upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/20px-Wiki_letter_w_cropped.svg.png" decoding="async" width="20" height="14" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/30px-Wiki_letter_w_cropped.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/1/1c/Wiki_letter_w_cropped.svg/40px-Wiki_letter_w_cropped.svg.png 2x" data-file-width="44" data-file-height="31" /></a></span></td><td class="mbox-text"><div class="mbox-text-span">This section <b>needs expansion</b>. You can help by <a class="external text" href="https://en.wikipedia.org/w/index.php?title=Colorectal_cancer&action=edit&section=">adding to it</a>. <span class="date-container"><i>(<span class="date">January 2024</span>)</i></span></div></td></tr></tbody></table> <p>Rectal cancer has been diagnosed in an Ancient Egyptian <a href="/wiki/Mummy" title="Mummy">mummy</a> who had lived in the <a href="/wiki/Dakhleh_Oasis" class="mw-redirect" title="Dakhleh Oasis">Dakhleh Oasis</a> during the <a href="/wiki/Ptolemaic_period" class="mw-redirect" title="Ptolemaic period">Ptolemaic period</a>.<sup id="cite_ref-214" class="reference"><a href="#cite_note-214"><span class="cite-bracket">[</span>214<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Society_and_culture">Society and culture</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=44" title="Edit section: Society and culture"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/List_of_people_diagnosed_with_colorectal_cancer" title="List of people diagnosed with colorectal cancer">List of people diagnosed with colorectal cancer</a></div> <p>In the United States, March is <a href="/wiki/National_Colon_Cancer_Awareness_Month" title="National Colon Cancer Awareness Month">colorectal cancer awareness month</a>.<sup id="cite_ref-Screen11_119-1" class="reference"><a href="#cite_note-Screen11-119"><span class="cite-bracket">[</span>119<span class="cite-bracket">]</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Research">Research</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=45" title="Edit section: Research"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1251242444"><table class="box-Update plainlinks metadata ambox ambox-content ambox-Update" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><span><img alt="" src="//upload.wikimedia.org/wikipedia/commons/thumb/5/53/Ambox_current_red_Americas.svg/42px-Ambox_current_red_Americas.svg.png" decoding="async" width="42" height="34" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/5/53/Ambox_current_red_Americas.svg/63px-Ambox_current_red_Americas.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/5/53/Ambox_current_red_Americas.svg/84px-Ambox_current_red_Americas.svg.png 2x" data-file-width="360" data-file-height="290" /></span></span></div></td><td class="mbox-text"><div class="mbox-text-span">This section needs to be <b>updated</b>. The reason given is: all sources > 5 years.<span class="hide-when-compact"> Please help update this article to reflect recent events or newly available information.</span> <span class="date-container"><i>(<span class="date">January 2024</span>)</i></span></div></td></tr></tbody></table> <p>Preliminary <a href="/wiki/In-vitro" class="mw-redirect" title="In-vitro">in-vitro</a> evidence suggests <a href="/wiki/Lactic_acid_bacteria" title="Lactic acid bacteria">lactic acid bacteria</a> (e.g., <a href="/wiki/Lactobacilli" class="mw-redirect" title="Lactobacilli">lactobacilli</a>, <a href="/wiki/Streptococci" class="mw-redirect" title="Streptococci">streptococci</a> or <a href="/wiki/Lactococci" class="mw-redirect" title="Lactococci">lactococci</a>) may be protective against the development and progression of colorectal cancer through several mechanisms such as <a href="/wiki/Antioxidant" title="Antioxidant">antioxidant</a> activity, <a href="/wiki/Immunotherapy" title="Immunotherapy">immunomodulation</a>, promoting <a href="/wiki/Apoptosis" title="Apoptosis">programmed cell death</a>, <a href="/wiki/Cytostasis" title="Cytostasis">antiproliferative effects</a>, and <a href="/wiki/Epigenetic" class="mw-redirect" title="Epigenetic">epigenetic</a> modification of cancer cells.<sup id="cite_ref-Zhong2014_215-0" class="reference"><a href="#cite_note-Zhong2014-215"><span class="cite-bracket">[</span>215<span class="cite-bracket">]</span></a></sup> </p> <ul><li><a href="/wiki/The_Cancer_Genome_Atlas" title="The Cancer Genome Atlas">The Cancer Genome Atlas</a><sup id="cite_ref-Muzny-2012_54-2" class="reference"><a href="#cite_note-Muzny-2012-54"><span class="cite-bracket">[</span>54<span class="cite-bracket">]</span></a></sup></li> <li>The Colorectal Cancer Atlas integrating genomic and proteomic data pertaining to colorectal cancer tissues and cell lines have been developed.<sup id="cite_ref-216" class="reference"><a href="#cite_note-216"><span class="cite-bracket">[</span>216<span class="cite-bracket">]</span></a></sup></li></ul> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=46" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/Adenoma-carcinoma_sequence" class="mw-redirect" title="Adenoma-carcinoma sequence">Adenoma-carcinoma sequence</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=47" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output .reflist-lower-alpha{list-style-type:lower-alpha}.mw-parser-output .reflist-lower-greek{list-style-type:lower-greek}.mw-parser-output .reflist-lower-roman{list-style-type:lower-roman}</style><div class="reflist reflist-columns references-column-width" style="column-width: 30em;"> <ol class="references"> <li id="cite_note-NCI2014Pt-1"><span class="mw-cite-backlink">^ <a href="#cite_ref-NCI2014Pt_1-0"><sup><i><b>a</b></i></sup></a> <a href="#cite_ref-NCI2014Pt_1-1"><sup><i><b>b</b></i></sup></a> <a href="#cite_ref-NCI2014Pt_1-2"><sup><i><b>c</b></i></sup></a> <a href="#cite_ref-NCI2014Pt_1-3"><sup><i><b>d</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output .cs1-code{color:inherit;background:inherit;border:none;padding:inherit}.mw-parser-output .cs1-hidden-error{display:none;color:var(--color-error,#d33)}.mw-parser-output .cs1-visible-error{color:var(--color-error,#d33)}.mw-parser-output .cs1-maint{display:none;color:#085;margin-left:0.3em}.mw-parser-output .cs1-kern-left{padding-left:0.2em}.mw-parser-output .cs1-kern-right{padding-right:0.2em}.mw-parser-output .citation .mw-selflink{font-weight:inherit}@media screen{.mw-parser-output .cs1-format{font-size:95%}html.skin-theme-clientpref-night .mw-parser-output .cs1-maint{color:#18911f}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .cs1-maint{color:#18911f}}</style><cite class="citation web cs1"><a rel="nofollow" class="external text" href="https://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient">"General Information About Colon Cancer"</a>. <i>NCI</i>. May 12, 2014. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20140704182634/http://www.cancer.gov/cancertopics/pdq/treatment/colon/Patient">Archived</a> from the original on July 4, 2014<span class="reference-accessdate">. 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href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071594">8071594</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/33313657">33313657</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=The+European+Journal+of+Public+Health&rft.atitle=Inequalities+and+risk+factors+related+to+non-participation+in+colorectal+cancer+screening+programmes%3A+a+systematic+review&rft.volume=31&rft.issue=2&rft.pages=%3Cspan+class%3D%22nowrap%22%3E346-%3C%2Fspan%3E355&rft.date=2020-12-12&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC8071594%23id-name%3DPMC&rft.issn=1101-1262&rft_id=info%3Apmid%2F33313657&rft_id=info%3Adoi%2F10.1093%2Feurpub%2Fckaa203&rft.aulast=Unanue-Arza&rft.aufirst=Saloa&rft.au=Sol%C3%ADs-Ibinagagoitia%2C+Maite&rft.au=D%C3%ADaz-Seoane%2C+Marta&rft.au=Mosquera-Metcalfe%2C+Isabel&rft.au=Idigoras%2C+Isabel&rft.au=Bilbao%2C+Isabel&rft.au=Portillo%2C+Isabel&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC8071594&rfr_id=info%3Asid%2Fen.wikipedia.org%3AColorectal+cancer" class="Z3988"></span></span> </li> <li id="cite_note-214"><span class="mw-cite-backlink"><b><a href="#cite_ref-214">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFRehemtulla2010" class="citation journal cs1">Rehemtulla A (December 2010). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003131">"Dinosaurs and ancient civilizations: reflections on the treatment of cancer"</a>. <i>Neoplasia</i>. <b>12</b> (12): <span class="nowrap">957–</span>968. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<a rel="nofollow" class="external text" href="https://doi.org/10.1593%2Fneo.101588">10.1593/neo.101588</a>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3003131">3003131</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/21170260">21170260</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=Neoplasia&rft.atitle=Dinosaurs+and+ancient+civilizations%3A+reflections+on+the+treatment+of+cancer&rft.volume=12&rft.issue=12&rft.pages=%3Cspan+class%3D%22nowrap%22%3E957-%3C%2Fspan%3E968&rft.date=2010-12&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3003131%23id-name%3DPMC&rft_id=info%3Apmid%2F21170260&rft_id=info%3Adoi%2F10.1593%2Fneo.101588&rft.aulast=Rehemtulla&rft.aufirst=A&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC3003131&rfr_id=info%3Asid%2Fen.wikipedia.org%3AColorectal+cancer" class="Z3988"></span></span> </li> <li id="cite_note-Zhong2014-215"><span class="mw-cite-backlink"><b><a href="#cite_ref-Zhong2014_215-0">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite id="CITEREFZhongZhangCovasa2014" class="citation journal cs1">Zhong L, Zhang X, Covasa M (June 2014). <a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4069315">"Emerging roles of lactic acid bacteria in protection against colorectal cancer"</a>. <i>World Journal of Gastroenterology</i>. <b>20</b> (24): <span class="nowrap">7878–</span>7886. <a href="/wiki/Doi_(identifier)" class="mw-redirect" title="Doi (identifier)">doi</a>:<span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://doi.org/10.3748%2Fwjg.v20.i24.7878">10.3748/wjg.v20.i24.7878</a></span>. <a href="/wiki/PMC_(identifier)" class="mw-redirect" title="PMC (identifier)">PMC</a> <span class="id-lock-free" title="Freely accessible"><a rel="nofollow" class="external text" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4069315">4069315</a></span>. <a href="/wiki/PMID_(identifier)" class="mw-redirect" title="PMID (identifier)">PMID</a> <a rel="nofollow" class="external text" href="https://pubmed.ncbi.nlm.nih.gov/24976724">24976724</a>.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.jtitle=World+Journal+of+Gastroenterology&rft.atitle=Emerging+roles+of+lactic+acid+bacteria+in+protection+against+colorectal+cancer&rft.volume=20&rft.issue=24&rft.pages=%3Cspan+class%3D%22nowrap%22%3E7878-%3C%2Fspan%3E7886&rft.date=2014-06&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4069315%23id-name%3DPMC&rft_id=info%3Apmid%2F24976724&rft_id=info%3Adoi%2F10.3748%2Fwjg.v20.i24.7878&rft.aulast=Zhong&rft.aufirst=L&rft.au=Zhang%2C+X&rft.au=Covasa%2C+M&rft_id=https%3A%2F%2Fwww.ncbi.nlm.nih.gov%2Fpmc%2Farticles%2FPMC4069315&rfr_id=info%3Asid%2Fen.wikipedia.org%3AColorectal+cancer" class="Z3988"></span></span> </li> <li id="cite_note-216"><span class="mw-cite-backlink"><b><a href="#cite_ref-216">^</a></b></span> <span class="reference-text"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1238218222"><cite class="citation web cs1"><a rel="nofollow" class="external text" href="http://colonatlas.org">"Colorectal Cancer Atlas"</a>. <a rel="nofollow" class="external text" href="https://web.archive.org/web/20160113221047/http://www.colonatlas.org/">Archived</a> from the original on January 13, 2016.</cite><span title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Abook&rft.genre=unknown&rft.btitle=Colorectal+Cancer+Atlas&rft_id=http%3A%2F%2Fcolonatlas.org&rfr_id=info%3Asid%2Fen.wikipedia.org%3AColorectal+cancer" class="Z3988"></span></span> </li> </ol></div> <div class="mw-heading mw-heading2"><h2 id="External_links">External links</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Colorectal_cancer&action=edit&section=48" title="Edit section: External links"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1236075235">.mw-parser-output .navbox{box-sizing:border-box;border:1px solid #a2a9b1;width:100%;clear:both;font-size:88%;text-align:center;padding:1px;margin:1em auto 0}.mw-parser-output .navbox .navbox{margin-top:0}.mw-parser-output .navbox+.navbox,.mw-parser-output .navbox+.navbox-styles+.navbox{margin-top:-1px}.mw-parser-output .navbox-inner,.mw-parser-output .navbox-subgroup{width:100%}.mw-parser-output .navbox-group,.mw-parser-output .navbox-title,.mw-parser-output .navbox-abovebelow{padding:0.25em 1em;line-height:1.5em;text-align:center}.mw-parser-output .navbox-group{white-space:nowrap;text-align:right}.mw-parser-output .navbox,.mw-parser-output .navbox-subgroup{background-color:#fdfdfd}.mw-parser-output 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td.hlist ul{padding:0.125em 0}.mw-parser-output .navbox .navbar{display:block;font-size:100%}.mw-parser-output .navbox-title .navbar{float:left;text-align:left;margin-right:0.5em}body.skin--responsive .mw-parser-output .navbox-image img{max-width:none!important}@media print{body.ns-0 .mw-parser-output .navbox{display:none!important}}</style><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"></div><div role="navigation" class="navbox" aria-label="Navbox32" style="width:100%; margin:0.5em 0 0.5em 0;;padding:3px"><table class="nowraplinks navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">Classification</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"><div style="position:relative; float:right; font-size:0.8em;"><a href="https://www.wikidata.org/wiki/Q188874" class="extiw" title="d:Q188874">D</a></div><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/ICD-10" title="ICD-10">10</a></b>: <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/C18">C18</a>, <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/C19">C19</a>, <a rel="nofollow" class="external text" href="https://icd.who.int/browse10/2019/en#/C20">C20</a></li><li><b><a href="/wiki/International_Statistical_Classification_of_Diseases_and_Related_Health_Problems" class="mw-redirect" title="International Statistical Classification of Diseases and Related Health Problems">ICD</a>-<a href="/wiki/List_of_ICD-9_codes" title="List of ICD-9 codes">9-CM</a></b>: <a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=153.0">153.0</a>-<a rel="nofollow" class="external text" href="http://www.icd9data.com/getICD9Code.ashx?icd9=154.1">154.1</a></li><li><b><a href="/wiki/International_Classification_of_Diseases_for_Oncology" title="International Classification of Diseases for Oncology">ICD-O</a></b>: <a rel="nofollow" class="external text" href="https://progenetix.org/subsets/?term_id=icdom:8140_3">M8140/3</a> (95% of cases)</li><li><b><a href="/wiki/Online_Mendelian_Inheritance_in_Man" title="Online Mendelian Inheritance in Man">OMIM</a></b>: <a rel="nofollow" class="external text" href="https://omim.org/entry/114500">114500</a></li><li><b><a href="/wiki/Diseases_Database" title="Diseases Database">DiseasesDB</a></b>: <a rel="nofollow" class="external text" href="http://www.diseasesdatabase.com/ddb2975.htm">2975</a></li></ul></div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%;background: #EAECF0;color:black;">External resources</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"><div class="hlist" style="text-align:left;"><ul><li><b><a href="/wiki/MedlinePlus" title="MedlinePlus">MedlinePlus</a></b>: <a rel="nofollow" class="external text" href="https://www.nlm.nih.gov/medlineplus/ency/article/000262.htm">000262</a></li><li><b><a href="/wiki/EMedicine" title="EMedicine">eMedicine</a></b>: <a rel="nofollow" class="external text" href="https://emedicine.medscape.com/med/413-overview">med/413</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/med/topic1994.htm#">med/1994</a> <a rel="nofollow" class="external text" href="https://www.emedicine.com/ped/topic3037.htm#">ped/3037</a></li><li><b><a href="/wiki/Patient_UK" title="Patient UK">Patient UK</a></b>: <a rel="nofollow" class="external text" href="https://patient.info/doctor/colorectal-cancer">Colorectal cancer</a></li><li><b><a href="/wiki/National_Cancer_Institute" title="National Cancer Institute">NCI</a></b>: <a rel="nofollow" class="external text" href="https://www.cancer.gov/colon-and-rectal">Colorectal cancer</a></li></ul></div></div></td></tr></tbody></table></div> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid #aaa;font-size:88%;line-height:1.25em;background-color:var(--background-color-interactive-subtle,#f8f9fa);display:flow-root}.mw-parser-output .side-box-abovebelow,.mw-parser-output .side-box-text{padding:0.25em 0.9em}.mw-parser-output .side-box-image{padding:2px 0 2px 0.9em;text-align:center}.mw-parser-output .side-box-imageright{padding:2px 0.9em 2px 0;text-align:center}@media(min-width:500px){.mw-parser-output .side-box-flex{display:flex;align-items:center}.mw-parser-output .side-box-text{flex:1;min-width:0}}@media(min-width:720px){.mw-parser-output .side-box{width:238px}.mw-parser-output .side-box-right{clear:right;float:right;margin-left:1em}.mw-parser-output .side-box-left{margin-right:1em}}</style><style data-mw-deduplicate="TemplateStyles:r1237033735">@media print{body.ns-0 .mw-parser-output .sistersitebox{display:none!important}}@media screen{html.skin-theme-clientpref-night .mw-parser-output .sistersitebox img[src*="Wiktionary-logo-en-v2.svg"]{background-color:white}}@media screen and (prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .sistersitebox img[src*="Wiktionary-logo-en-v2.svg"]{background-color:white}}</style><div class="side-box side-box-right plainlinks sistersitebox"><style data-mw-deduplicate="TemplateStyles:r1126788409">.mw-parser-output .plainlist ol,.mw-parser-output .plainlist ul{line-height:inherit;list-style:none;margin:0;padding:0}.mw-parser-output .plainlist ol li,.mw-parser-output .plainlist ul li{margin-bottom:0}</style> <div class="side-box-flex"> <div class="side-box-image"><span class="noviewer" typeof="mw:File"><a href="/wiki/File:Commons-logo.svg" class="mw-file-description"><img alt="" src="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/30px-Commons-logo.svg.png" decoding="async" width="30" height="40" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/45px-Commons-logo.svg.png 1.5x, //upload.wikimedia.org/wikipedia/en/thumb/4/4a/Commons-logo.svg/59px-Commons-logo.svg.png 2x" data-file-width="1024" data-file-height="1376" /></a></span></div> <div class="side-box-text plainlist">Wikimedia Commons has media related to <span style="font-weight: bold; font-style: italic;"><a href="https://commons.wikimedia.org/wiki/Category:Colorectal_cancer" class="extiw" title="commons:Category:Colorectal cancer">Colorectal cancer</a></span>.</div></div> </div> <ul><li><a rel="nofollow" class="external text" href="https://www.who.int/news-room/fact-sheets/detail/colorectal-cancer">WHO fact sheet on colorectal cancer</a></li></ul> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Diseases_of_the_human_digestive_system290" style="padding:3px"><table class="nowraplinks mw-collapsible mw-collapsed navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><style data-mw-deduplicate="TemplateStyles:r1239400231">.mw-parser-output .navbar{display:inline;font-size:88%;font-weight:normal}.mw-parser-output .navbar-collapse{float:left;text-align:left}.mw-parser-output .navbar-boxtext{word-spacing:0}.mw-parser-output .navbar ul{display:inline-block;white-space:nowrap;line-height:inherit}.mw-parser-output .navbar-brackets::before{margin-right:-0.125em;content:"[ "}.mw-parser-output .navbar-brackets::after{margin-left:-0.125em;content:" ]"}.mw-parser-output .navbar li{word-spacing:-0.125em}.mw-parser-output .navbar a>span,.mw-parser-output .navbar a>abbr{text-decoration:inherit}.mw-parser-output .navbar-mini abbr{font-variant:small-caps;border-bottom:none;text-decoration:none;cursor:inherit}.mw-parser-output .navbar-ct-full{font-size:114%;margin:0 7em}.mw-parser-output .navbar-ct-mini{font-size:114%;margin:0 4em}html.skin-theme-clientpref-night .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}@media(prefers-color-scheme:dark){html.skin-theme-clientpref-os .mw-parser-output .navbar li a abbr{color:var(--color-base)!important}}@media print{.mw-parser-output .navbar{display:none!important}}</style><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Digestive_system_diseases" title="Template:Digestive system diseases"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Digestive_system_diseases" title="Template talk:Digestive system diseases"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Digestive_system_diseases" title="Special:EditPage/Template:Digestive system diseases"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Diseases_of_the_human_digestive_system290" style="font-size:114%;margin:0 4em">Diseases of the <a href="/wiki/Human_digestive_system" title="Human digestive system">human digestive system</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gastrointestinal_tract#Upper_gastrointestinal_tract" title="Gastrointestinal tract">Upper GI tract</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Esophageal_disease" title="Esophageal disease">Esophagus</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Esophagitis" title="Esophagitis">Esophagitis</a> <ul><li><a href="/wiki/Esophageal_candidiasis" title="Esophageal candidiasis">Candidal</a></li> <li><a href="/wiki/Eosinophilic_esophagitis" title="Eosinophilic esophagitis">Eosinophilic</a></li> <li><a href="/wiki/Herpetiform_esophagitis" class="mw-redirect" title="Herpetiform esophagitis">Herpetiform</a></li></ul></li> <li><i>Rupture</i> <ul><li><a href="/wiki/Boerhaave_syndrome" class="mw-redirect" title="Boerhaave syndrome">Boerhaave syndrome</a></li> <li><a href="/wiki/Mallory%E2%80%93Weiss_syndrome" title="Mallory–Weiss syndrome">Mallory–Weiss syndrome</a></li></ul></li> <li><a href="/wiki/Zenker%27s_diverticulum" title="Zenker's diverticulum">Zenker's diverticulum</a></li> <li><a href="/wiki/Barrett%27s_esophagus" title="Barrett's esophagus">Barrett's esophagus</a></li> <li><a href="/wiki/Esophageal_motility_disorder" title="Esophageal motility disorder">Esophageal motility disorder</a> <ul><li><a href="/wiki/Nutcracker_esophagus" title="Nutcracker esophagus">Nutcracker esophagus</a></li> <li><a href="/wiki/Achalasia" class="mw-redirect" title="Achalasia">Achalasia</a></li> <li><a href="/wiki/Esophagogastric_junction_outflow_obstruction" title="Esophagogastric junction outflow obstruction">Esophagogastric junction outflow obstruction</a></li> <li><a href="/wiki/Diffuse_esophageal_spasm" title="Diffuse esophageal spasm">Diffuse esophageal spasm</a></li> <li><a href="/wiki/Gastroesophageal_reflux_disease" title="Gastroesophageal reflux disease">Gastroesophageal reflux disease</a> (GERD)</li></ul></li> <li><a href="/wiki/Laryngopharyngeal_reflux" title="Laryngopharyngeal reflux">Laryngopharyngeal reflux</a> (LPR)</li> <li><a href="/wiki/Esophageal_stricture" title="Esophageal stricture">Esophageal stricture</a></li> <li><a href="/wiki/Esophageal_inlet_patch" title="Esophageal inlet patch">Inlet patch</a></li> <li><a href="/wiki/Megaesophagus" title="Megaesophagus">Megaesophagus</a></li> <li><a href="/wiki/Esophageal_intramural_pseudodiverticulosis" title="Esophageal intramural pseudodiverticulosis">Esophageal intramural pseudodiverticulosis</a></li> <li><a href="/wiki/Acute_esophageal_necrosis" title="Acute esophageal necrosis">Acute esophageal necrosis</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Stomach_disease" title="Stomach disease">Stomach</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gastritis" title="Gastritis">Gastritis</a> <ul><li><a href="/wiki/Atrophic_gastritis" title="Atrophic gastritis">Atrophic</a></li> <li><a href="/wiki/M%C3%A9n%C3%A9trier%27s_disease" title="Ménétrier's disease">Ménétrier's disease</a></li> <li><a href="/wiki/Gastroenteritis" title="Gastroenteritis">Gastroenteritis</a></li></ul></li> <li><a href="/wiki/Peptic_ulcer" class="mw-redirect" title="Peptic ulcer">Peptic (gastric) ulcer</a> <ul><li><a href="/wiki/Cushing_ulcer" title="Cushing ulcer">Cushing ulcer</a></li> <li><a href="/wiki/Dieulafoy%27s_lesion" title="Dieulafoy's lesion">Dieulafoy's lesion</a></li></ul></li> <li><a href="/wiki/Dyspepsia" class="mw-redirect" title="Dyspepsia">Dyspepsia</a> <ul><li><a href="/wiki/Functional_dyspepsia" title="Functional dyspepsia">Functional dyspepsia</a></li></ul></li> <li><a href="/wiki/Pyloric_stenosis" title="Pyloric stenosis">Pyloric stenosis</a></li> <li><a href="/wiki/Achlorhydria" title="Achlorhydria">Achlorhydria</a></li> <li><a href="/wiki/Gastroparesis" title="Gastroparesis">Gastroparesis</a></li> <li><a href="/wiki/Gastroptosis" title="Gastroptosis">Gastroptosis</a></li> <li><a href="/wiki/Portal_hypertensive_gastropathy" title="Portal hypertensive gastropathy">Portal hypertensive gastropathy</a></li> <li><a href="/wiki/Gastric_antral_vascular_ectasia" title="Gastric antral vascular ectasia">Gastric antral vascular ectasia</a></li> <li><a href="/wiki/Gastric_dumping_syndrome" class="mw-redirect" title="Gastric dumping syndrome">Gastric dumping syndrome</a></li> <li><a href="/wiki/Gastric_volvulus" title="Gastric volvulus">Gastric volvulus</a></li> <li><a href="/wiki/Buried_bumper_syndrome" title="Buried bumper syndrome">Buried bumper syndrome</a></li> <li><a href="/wiki/Gastrinoma" title="Gastrinoma">Gastrinoma</a> <ul><li><a href="/wiki/Zollinger%E2%80%93Ellison_syndrome" title="Zollinger–Ellison syndrome">Zollinger–Ellison syndrome</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gastrointestinal_tract#Lower_gastrointestinal_tract" title="Gastrointestinal tract">Lower GI tract</a> <br /> <a href="/wiki/Enteropathy" title="Enteropathy">Enteropathy</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Small_intestine" title="Small intestine">Small intestine</a> <br /> (<a href="/wiki/Duodenum" title="Duodenum">Duodenum</a>/<a href="/wiki/Jejunum" title="Jejunum">Jejunum</a>/<a href="/wiki/Ileum" title="Ileum">Ileum</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Enteritis" title="Enteritis">Enteritis</a> <ul><li><a href="/wiki/Duodenitis" title="Duodenitis">Duodenitis</a></li> <li><a href="/wiki/Jejunitis" title="Jejunitis">Jejunitis</a></li> <li><a href="/wiki/Ileitis" title="Ileitis">Ileitis</a></li></ul></li> <li><a href="/wiki/Peptic_ulcer" class="mw-redirect" title="Peptic ulcer">Peptic (duodenal) ulcer</a> <ul><li><a href="/wiki/Curling%27s_ulcer" title="Curling's ulcer">Curling's ulcer</a></li></ul></li> <li><a href="/wiki/Malabsorption" title="Malabsorption">Malabsorption</a>: <a href="/wiki/Coeliac_disease" title="Coeliac disease">Coeliac</a></li> <li><a href="/wiki/Tropical_sprue" title="Tropical sprue">Tropical sprue</a></li> <li><a href="/wiki/Blind_loop_syndrome" title="Blind loop syndrome">Blind loop syndrome</a></li> <li><a href="/wiki/Small_intestinal_bacterial_overgrowth" title="Small intestinal bacterial overgrowth">Small intestinal bacterial overgrowth</a></li> <li><a href="/wiki/Whipple%27s_disease" title="Whipple's disease">Whipple's</a></li> <li><a href="/wiki/Short_bowel_syndrome" title="Short bowel syndrome">Short bowel syndrome</a></li> <li><a href="/wiki/Steatorrhea" title="Steatorrhea">Steatorrhea</a></li> <li><a href="/wiki/Milroy_disease" class="mw-redirect" title="Milroy disease">Milroy disease</a></li> <li><a href="/wiki/Bile_acid_malabsorption" title="Bile acid malabsorption">Bile acid malabsorption</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Large_intestine" title="Large intestine">Large intestine</a> <br /> (<a href="/wiki/Vermiform_appendix" class="mw-redirect" title="Vermiform appendix">Appendix</a>/<a href="/wiki/Colon_(anatomy)" class="mw-redirect" title="Colon (anatomy)">Colon</a>)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Appendicitis" title="Appendicitis">Appendicitis</a></li> <li><a href="/wiki/Colitis" title="Colitis">Colitis</a> <ul><li><a href="/wiki/Pseudomembranous_colitis" class="mw-redirect" title="Pseudomembranous colitis">Pseudomembranous</a></li> <li><a href="/wiki/Ulcerative_colitis" title="Ulcerative colitis">Ulcerative</a></li> <li><a href="/wiki/Ischemic_colitis" title="Ischemic colitis">Ischemic</a></li> <li><a href="/wiki/Microscopic_colitis" title="Microscopic colitis">Microscopic</a></li> <li><a href="/wiki/Collagenous_colitis" title="Collagenous colitis">Collagenous</a></li> <li><a href="/wiki/Lymphocytic_colitis" title="Lymphocytic colitis">Lymphocytic</a></li></ul></li> <li><a href="/wiki/Dysentery" title="Dysentery">Dysentery</a></li> <li><a href="/wiki/Functional_colonic_disease" class="mw-redirect" title="Functional colonic disease">Functional colonic disease</a> <ul><li><a href="/wiki/Irritable_bowel_syndrome" title="Irritable bowel syndrome">IBS</a></li> <li><a href="/wiki/Intestinal_pseudoobstruction" class="mw-redirect" title="Intestinal pseudoobstruction">Intestinal pseudoobstruction</a> / <a href="/wiki/Ogilvie_syndrome" title="Ogilvie syndrome">Ogilvie syndrome</a></li></ul></li> <li><a href="/wiki/Megacolon" title="Megacolon">Megacolon</a> / <a href="/wiki/Toxic_megacolon" title="Toxic megacolon">Toxic megacolon</a></li> <li><a href="/wiki/Diverticulitis" title="Diverticulitis">Diverticulitis</a>/<a href="/wiki/Diverticulosis" title="Diverticulosis">Diverticulosis</a>/<a href="/wiki/Segmental_colitis_associated_with_diverticulosis" title="Segmental colitis associated with diverticulosis">SCAD</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Large and/or small</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Enterocolitis" title="Enterocolitis">Enterocolitis</a> <ul><li><a href="/wiki/Necrotizing_enterocolitis" title="Necrotizing enterocolitis">Necrotizing</a></li></ul></li> <li><a href="/wiki/Gastroenterocolitis" title="Gastroenterocolitis">Gastroenterocolitis</a></li> <li><a href="/wiki/Inflammatory_bowel_disease" title="Inflammatory bowel disease">IBD</a> <ul><li><a href="/wiki/Crohn%27s_disease" title="Crohn's disease">Crohn's disease</a></li></ul></li> <li><i><a href="/wiki/Vascular_disease" title="Vascular disease">Vascular</a></i>: <a href="/wiki/Abdominal_angina" title="Abdominal angina">Abdominal angina</a></li> <li><a href="/wiki/Mesenteric_ischemia" class="mw-redirect" title="Mesenteric ischemia">Mesenteric ischemia</a></li> <li><a href="/wiki/Angiodysplasia" title="Angiodysplasia">Angiodysplasia</a></li> <li><a href="/wiki/Bowel_obstruction" title="Bowel obstruction">Bowel obstruction</a>: <a href="/wiki/Ileus" title="Ileus">Ileus</a></li> <li><a href="/wiki/Intussusception_(medical_disorder)" title="Intussusception (medical disorder)">Intussusception</a></li> <li><a href="/wiki/Volvulus" title="Volvulus">Volvulus</a></li> <li><a href="/wiki/Fecal_impaction" title="Fecal impaction">Fecal impaction</a></li> <li><a href="/wiki/Constipation" title="Constipation">Constipation</a> <ul><li><a href="/wiki/Functional_constipation" title="Functional constipation">Functional</a></li></ul></li> <li><a href="/wiki/Diarrhea" title="Diarrhea">Diarrhea</a> <ul><li><a href="/wiki/Infectious_diarrhea" class="mw-redirect" title="Infectious diarrhea">Infectious</a></li></ul></li> <li><a href="/wiki/Adhesion_(medicine)" title="Adhesion (medicine)">Intestinal adhesions</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Rectum" title="Rectum">Rectum</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Proctitis" title="Proctitis">Proctitis</a> <ul><li><a href="/wiki/Radiation_proctitis" title="Radiation proctitis">Radiation proctitis</a></li></ul></li> <li><a href="/wiki/Proctalgia_fugax" title="Proctalgia fugax">Proctalgia fugax</a></li> <li><a href="/wiki/Rectal_prolapse" title="Rectal prolapse">Rectal prolapse</a> (<a href="/wiki/Internal_rectal_prolapse" title="Internal rectal prolapse">Internal rectal prolapse</a>)</li> <li><a href="/wiki/Anismus" title="Anismus">Anismus</a></li> <li><a href="/wiki/Solitary_rectal_ulcer_syndrome" title="Solitary rectal ulcer syndrome">Solitary rectal ulcer syndrome</a></li> <li><a href="/wiki/Rectal_stricture" title="Rectal stricture">Rectal stricture</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Anal_canal" title="Anal canal">Anal canal</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Anal_fissure" title="Anal fissure">Anal fissure</a>/<a href="/wiki/Anal_fistula" title="Anal fistula">Anal fistula</a></li> <li><a href="/wiki/Anal_abscess" class="mw-redirect" title="Anal abscess">Anal abscess</a></li> <li><a href="/wiki/Hemorrhoid" title="Hemorrhoid">Hemorrhoid</a></li> <li><a href="/wiki/Anal_dysplasia" title="Anal dysplasia">Anal dysplasia</a></li> <li><a href="/wiki/Pruritus_ani" title="Pruritus ani">Pruritus ani</a></li> <li><a href="/wiki/Anal_stricture" title="Anal stricture">Anal stricture</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gastrointestinal_bleeding" title="Gastrointestinal bleeding">GI bleeding</a></th><td class="navbox-list-with-group navbox-list navbox-even hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Blood_in_stool" title="Blood in stool">Blood in stool</a></li> <li><a href="/wiki/Upper_gastrointestinal_bleeding" title="Upper gastrointestinal bleeding">Upper</a> <ul><li><a href="/wiki/Hematemesis" title="Hematemesis">Hematemesis</a></li> <li><a href="/wiki/Melena" title="Melena">Melena</a></li></ul></li> <li><a href="/wiki/Lower_gastrointestinal_bleeding" title="Lower gastrointestinal bleeding">Lower</a> <ul><li><a href="/wiki/Hematochezia" title="Hematochezia">Hematochezia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Accessory_digestive_gland" class="mw-redirect" title="Accessory digestive gland">Accessory</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Liver_disease" title="Liver disease">Liver</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Hepatitis" title="Hepatitis">Hepatitis</a> <ul><li><a href="/wiki/Viral_hepatitis" title="Viral hepatitis">Viral hepatitis</a></li> <li><a href="/wiki/Autoimmune_hepatitis" title="Autoimmune hepatitis">Autoimmune hepatitis</a></li> <li><a href="/wiki/Alcoholic_hepatitis" title="Alcoholic hepatitis">Alcoholic hepatitis</a></li></ul></li> <li><a href="/wiki/Cirrhosis" title="Cirrhosis">Cirrhosis</a> <ul><li><a href="/wiki/Primary_biliary_cirrhosis" class="mw-redirect" title="Primary biliary cirrhosis">PBC</a></li></ul></li> <li><a href="/wiki/Fatty_liver" class="mw-redirect" title="Fatty liver">Fatty liver</a> <ul><li><a href="/wiki/Metabolic_dysfunction%E2%80%93associated_steatotic_liver_disease" title="Metabolic dysfunction–associated steatotic liver disease">MASLD</a></li></ul></li> <li><i><a href="/wiki/Vascular_disease" title="Vascular disease">Vascular</a></i> <ul><li><a href="/wiki/Budd%E2%80%93Chiari_syndrome" title="Budd–Chiari syndrome">Budd–Chiari syndrome</a></li> <li><a href="/wiki/Hepatic_veno-occlusive_disease" title="Hepatic veno-occlusive disease">Hepatic veno-occlusive disease</a></li> <li><a href="/wiki/Portal_hypertension" title="Portal hypertension">Portal hypertension</a></li> <li><a href="/wiki/Nutmeg_liver" class="mw-redirect" title="Nutmeg liver">Nutmeg liver</a></li></ul></li> <li><a href="/wiki/Alcoholic_liver_disease" title="Alcoholic liver disease">Alcoholic liver disease</a></li> <li><a href="/wiki/Liver_failure" title="Liver failure">Liver failure</a> <ul><li><a href="/wiki/Hepatic_encephalopathy" title="Hepatic encephalopathy">Hepatic encephalopathy</a></li> <li><a href="/wiki/Acute_liver_failure" title="Acute liver failure">Acute liver failure</a></li></ul></li> <li><a href="/wiki/Liver_abscess" title="Liver abscess">Liver abscess</a> <ul><li><a href="/wiki/Pyogenic_liver_abscess" title="Pyogenic liver abscess">Pyogenic</a></li> <li><a href="/wiki/Amoebic_liver_abscess" title="Amoebic liver abscess">Amoebic</a></li></ul></li> <li><a href="/wiki/Hepatorenal_syndrome" title="Hepatorenal syndrome">Hepatorenal syndrome</a></li> <li><a href="/wiki/Peliosis_hepatis" title="Peliosis hepatis">Peliosis hepatis</a></li> <li><a href="/wiki/Metabolic_disorder" title="Metabolic disorder">Metabolic disorders</a> <ul><li><a href="/wiki/Wilson%27s_disease" title="Wilson's disease">Wilson's disease</a></li> <li><a href="/wiki/Hemochromatosis" class="mw-redirect" title="Hemochromatosis">Hemochromatosis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Gallbladder_disease" title="Gallbladder disease">Gallbladder</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cholecystitis" title="Cholecystitis">Cholecystitis</a></li> <li><a href="/wiki/Gallstone" title="Gallstone">Gallstone / Cholelithiasis</a></li> <li><a href="/wiki/Cholesterolosis_of_gallbladder" title="Cholesterolosis of gallbladder">Cholesterolosis</a></li> <li><a href="/wiki/Adenomyomatosis" title="Adenomyomatosis">Adenomyomatosis</a></li> <li><a href="/wiki/Postcholecystectomy_syndrome" title="Postcholecystectomy syndrome">Postcholecystectomy syndrome</a></li> <li><a href="/wiki/Porcelain_gallbladder" title="Porcelain gallbladder">Porcelain gallbladder</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Bile_duct" title="Bile duct">Bile duct</a>/ <br /> Other <a href="/wiki/Biliary_tree" class="mw-redirect" title="Biliary tree">biliary tree</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Cholangitis" class="mw-redirect" title="Cholangitis">Cholangitis</a> <ul><li><a href="/wiki/Primary_sclerosing_cholangitis" title="Primary sclerosing cholangitis">Primary sclerosing cholangitis</a></li> <li><a href="/wiki/Secondary_sclerosing_cholangitis" title="Secondary sclerosing cholangitis">Secondary sclerosing cholangitis</a></li> <li><a href="/wiki/Ascending_cholangitis" title="Ascending cholangitis">Ascending</a></li></ul></li> <li><a href="/wiki/Cholestasis" title="Cholestasis">Cholestasis</a>/<a href="/wiki/Mirizzi%27s_syndrome" title="Mirizzi's syndrome">Mirizzi's syndrome</a></li> <li><a href="/wiki/Biliary_fistula" title="Biliary fistula">Biliary fistula</a></li> <li><a href="/wiki/Haemobilia" title="Haemobilia">Haemobilia</a></li></ul> <ul><li><i><a href="/wiki/Common_bile_duct" title="Common bile duct">Common bile duct</a></i> <ul><li><a href="/wiki/Choledocholithiasis" class="mw-redirect" title="Choledocholithiasis">Choledocholithiasis</a></li> <li><a href="/wiki/Biliary_dyskinesia" title="Biliary dyskinesia">Biliary dyskinesia</a></li></ul></li> <li><a href="/wiki/Sphincter_of_Oddi_dysfunction" title="Sphincter of Oddi dysfunction">Sphincter of Oddi dysfunction</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pancreatic_disease" title="Pancreatic disease">Pancreatic</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Pancreatitis" title="Pancreatitis">Pancreatitis</a> <ul><li><a href="/wiki/Acute_pancreatitis" title="Acute pancreatitis">Acute</a></li> <li><a href="/wiki/Chronic_pancreatitis" title="Chronic pancreatitis">Chronic</a></li> <li><a href="/wiki/Hereditary_pancreatitis" title="Hereditary pancreatitis">Hereditary</a></li> <li><a href="/wiki/Pancreatic_abscess" title="Pancreatic abscess">Pancreatic abscess</a></li></ul></li> <li><a href="/wiki/Pancreatic_pseudocyst" title="Pancreatic pseudocyst">Pancreatic pseudocyst</a></li> <li><a href="/wiki/Exocrine_pancreatic_insufficiency" title="Exocrine pancreatic insufficiency">Exocrine pancreatic insufficiency</a></li> <li><a href="/wiki/Pancreatic_fistula" title="Pancreatic fistula">Pancreatic fistula</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Other</th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th id="Hernia43" scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hernia" title="Hernia">Hernia</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Diaphragmatic_hernia" title="Diaphragmatic hernia">Diaphragmatic</a> <ul><li><a href="/wiki/Congenital_diaphragmatic_hernia" title="Congenital diaphragmatic hernia">Congenital</a></li></ul></li> <li><a href="/wiki/Hiatus_hernia" class="mw-redirect" title="Hiatus hernia">Hiatus</a></li></ul> <ul><li><a href="/wiki/Inguinal_hernia" title="Inguinal hernia">Inguinal</a> <ul><li><a href="/wiki/Indirect_inguinal_hernia" class="mw-redirect" title="Indirect inguinal hernia">Indirect</a></li> <li><a href="/wiki/Direct_inguinal_hernia" class="mw-redirect" title="Direct inguinal hernia">Direct</a></li></ul></li> <li><a href="/wiki/Umbilical_hernia" title="Umbilical hernia">Umbilical</a></li> <li><a href="/wiki/Femoral_hernia" title="Femoral hernia">Femoral</a></li> <li><a href="/wiki/Obturator_hernia" title="Obturator hernia">Obturator</a></li> <li><a href="/wiki/Spigelian_hernia" title="Spigelian hernia">Spigelian</a></li></ul> <ul><li><i><a href="/wiki/Lumbar_hernia" class="mw-redirect" title="Lumbar hernia">Lumbar</a></i> <ul><li><a href="/wiki/Petit%27s_hernia" title="Petit's hernia">Petit's</a></li> <li><a href="/wiki/Grynfeltt%E2%80%93Lesshaft_hernia" title="Grynfeltt–Lesshaft hernia">Grynfeltt–Lesshaft</a></li></ul></li></ul> <ul><li><i>Undefined location</i> <ul><li><a href="/wiki/Incisional_hernia" title="Incisional hernia">Incisional</a></li> <li><a href="/wiki/Internal_hernia" title="Internal hernia">Internal hernia</a></li> <li><a href="/wiki/Richter%27s_hernia" title="Richter's hernia">Richter's</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Peritoneal_disease" class="mw-redirect" title="Peritoneal disease">Peritoneal</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Peritonitis" title="Peritonitis">Peritonitis</a> <ul><li><a href="/wiki/Spontaneous_bacterial_peritonitis" title="Spontaneous bacterial peritonitis">Spontaneous bacterial peritonitis</a></li></ul></li> <li><a href="/wiki/Hemoperitoneum" title="Hemoperitoneum">Hemoperitoneum</a></li> <li><a href="/wiki/Pneumoperitoneum" title="Pneumoperitoneum">Pneumoperitoneum</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div class="navbox-styles"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236075235"></div><div role="navigation" class="navbox" aria-labelledby="Digestive_system_neoplasia150" style="padding:3px"><table class="nowraplinks mw-collapsible autocollapse navbox-inner" style="border-spacing:0;background:transparent;color:inherit"><tbody><tr><th scope="col" class="navbox-title" colspan="2"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1129693374"><link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1239400231"><div class="navbar plainlinks hlist navbar-mini"><ul><li class="nv-view"><a href="/wiki/Template:Digestive_system_neoplasia" title="Template:Digestive system neoplasia"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Digestive_system_neoplasia" title="Template talk:Digestive system neoplasia"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Digestive_system_neoplasia" title="Special:EditPage/Template:Digestive system neoplasia"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="Digestive_system_neoplasia150" style="font-size:114%;margin:0 4em"><a href="/wiki/Digestive_system_neoplasm" title="Digestive system neoplasm">Digestive system neoplasia</a></div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_gastrointestinal_tract" class="mw-redirect" title="Human gastrointestinal tract">GI tract</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Upper_alimentary_tract#Upper_gastrointestinal_tract" class="mw-redirect" title="Upper alimentary tract">Upper</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Esophageal_cancer" title="Esophageal cancer">Esophagus</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Squamous_cell_carcinoma" class="mw-redirect" title="Squamous cell carcinoma">Squamous cell carcinoma</a></li> <li><a href="/wiki/Adenocarcinoma" title="Adenocarcinoma">Adenocarcinoma</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Stomach_cancer" title="Stomach cancer">Stomach</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gastric_carcinoma" class="mw-redirect" title="Gastric carcinoma">Gastric carcinoma</a></li> <li><a href="/wiki/Signet_ring_cell_carcinoma" title="Signet ring cell carcinoma">Signet ring cell carcinoma</a></li> <li><a href="/wiki/Gastric_lymphoma" title="Gastric lymphoma">Gastric lymphoma</a> <ul><li><a href="/wiki/MALT_lymphoma" title="MALT lymphoma">MALT lymphoma</a></li></ul></li> <li><a href="/wiki/Linitis_plastica" title="Linitis plastica">Linitis plastica</a></li> <li><a href="/wiki/Hereditary_diffuse_gastric_cancer" title="Hereditary diffuse gastric cancer">Hereditary diffuse gastric cancer</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Human_gastrointestinal_tract#Lower_gastrointestinal_tract" class="mw-redirect" title="Human gastrointestinal tract">Lower</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Small_intestine_cancer" title="Small intestine cancer">Small intestine</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Duodenal_cancer" title="Duodenal cancer">Duodenal cancer</a> <ul><li><a href="/wiki/Adenocarcinoma" title="Adenocarcinoma">Adenocarcinoma</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Appendix_cancer" title="Appendix cancer">Appendix</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Carcinoid" title="Carcinoid">Carcinoid</a></li> <li><a href="/wiki/Pseudomyxoma_peritonei" title="Pseudomyxoma peritonei">Pseudomyxoma peritonei</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a class="mw-selflink selflink">Colon/rectum</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Colorectal_polyp" title="Colorectal polyp">Colorectal polyp</a>:</i> <a href="/wiki/Colorectal_adenoma" title="Colorectal adenoma">adenoma</a>, <a href="/wiki/Hyperplastic_polyp" title="Hyperplastic polyp">hyperplastic</a>, <a href="/wiki/Juvenile_polyp" title="Juvenile polyp">juvenile</a>, <a href="/wiki/Sessile_serrated_adenoma" class="mw-redirect" title="Sessile serrated adenoma">sessile serrated adenoma</a>, <a href="/wiki/Traditional_serrated_adenoma" title="Traditional serrated adenoma">traditional serrated adenoma</a>, <a href="/wiki/Peutz%E2%80%93Jeghers_syndrome" title="Peutz–Jeghers syndrome">Peutz–Jeghers</a>, <a href="/wiki/Cronkhite%E2%80%93Canada_syndrome" title="Cronkhite–Canada syndrome">Cronkhite–Canada</a></li></ul> <ul><li><i>Polyposis syndromes:</i> <a href="/wiki/Juvenile_polyposis_syndrome" title="Juvenile polyposis syndrome">Juvenile</a></li> <li><a href="/wiki/MUTYH-associated_polyposis" title="MUTYH-associated polyposis">MUTYH-associated</a></li> <li><a href="/wiki/Familial_adenomatous_polyposis" title="Familial adenomatous polyposis">Familial adenomatous</a>/<a href="/wiki/Gardner%27s_syndrome" title="Gardner's syndrome">Gardner's</a></li> <li><a href="/wiki/Polymerase_proofreading-associated_polyposis" title="Polymerase proofreading-associated polyposis">Polymerase proofreading-associated</a></li> <li><a href="/wiki/Serrated_polyposis_syndrome" title="Serrated polyposis syndrome">Serrated polyposis</a></li></ul> <ul><li><i>Neoplasm:</i> <a href="/wiki/Adenocarcinoma" title="Adenocarcinoma">Adenocarcinoma</a></li> <li><a href="/wiki/Familial_adenomatous_polyposis" title="Familial adenomatous polyposis">Familial adenomatous polyposis</a></li> <li><a href="/wiki/Hereditary_nonpolyposis_colorectal_cancer" title="Hereditary nonpolyposis colorectal cancer">Hereditary nonpolyposis colorectal cancer</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Anal_cancer" title="Anal cancer">Anus</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Squamous_cell_carcinoma" class="mw-redirect" title="Squamous cell carcinoma">Squamous cell carcinoma</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">Upper and/or lower</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Gastrointestinal_stromal_tumor" title="Gastrointestinal stromal tumor">Gastrointestinal stromal tumor</a></li> <li><a href="/wiki/Krukenberg_tumor" title="Krukenberg tumor">Krukenberg tumor (metastatic)</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Accessory_digestive_gland" class="mw-redirect" title="Accessory digestive gland">Accessory</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Liver_tumor" title="Liver tumor">Liver</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Malignant" class="mw-redirect" title="Malignant">malignant</a>:</i> <a href="/wiki/Hepatocellular_carcinoma" title="Hepatocellular carcinoma">Hepatocellular carcinoma</a> <ul><li><a href="/wiki/Fibrolamellar_hepatocellular_carcinoma" title="Fibrolamellar hepatocellular carcinoma">Fibrolamellar</a></li></ul></li> <li><a href="/wiki/Hepatoblastoma" title="Hepatoblastoma">Hepatoblastoma</a></li> <li><a href="/wiki/Liver_angiosarcoma" title="Liver angiosarcoma">Liver angiosarcoma</a></li></ul> <ul><li><i><a href="/wiki/Benign_tumor" title="Benign tumor">benign</a>:</i> <a href="/wiki/Hepatocellular_adenoma" title="Hepatocellular adenoma">Hepatocellular adenoma</a></li> <li><a href="/wiki/Cavernous_hemangioma" title="Cavernous hemangioma">Cavernous hemangioma</a></li></ul> <ul><li><i><a href="/wiki/Hyperplasia" title="Hyperplasia">hyperplasia</a>:</i> <a href="/wiki/Focal_nodular_hyperplasia" title="Focal nodular hyperplasia">Focal nodular hyperplasia</a></li> <li><a href="/wiki/Nodular_regenerative_hyperplasia" title="Nodular regenerative hyperplasia">Nodular regenerative hyperplasia</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Biliary_tract" title="Biliary tract">Biliary tract</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Bile_duct" title="Bile duct">bile duct</a>:</i> <a href="/wiki/Cholangiocarcinoma" title="Cholangiocarcinoma">Cholangiocarcinoma</a></li> <li><a href="/wiki/Klatskin_tumor" title="Klatskin tumor">Klatskin tumor</a></li></ul> <ul><li><i><a href="/wiki/Gallbladder" title="Gallbladder">gallbladder</a>:</i> <a href="/wiki/Gallbladder_cancer" title="Gallbladder cancer">Gallbladder cancer</a></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Pancreatic_cancer" title="Pancreatic cancer">Pancreas</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Exocrine_pancreas" class="mw-redirect" title="Exocrine pancreas">exocrine pancreas</a>:</i> <a href="/wiki/Adenocarcinoma" title="Adenocarcinoma">Adenocarcinoma</a></li> <li><a href="/wiki/Pancreatic_ductal_carcinoma" class="mw-redirect" title="Pancreatic ductal carcinoma">Pancreatic ductal carcinoma</a></li></ul> <ul><li><i><a href="/wiki/Cyst" title="Cyst">cystic</a> <a href="/wiki/Neoplasm" title="Neoplasm">neoplasms</a></i>: <a href="/wiki/Serous_microcystic_adenoma" class="mw-redirect" title="Serous microcystic adenoma">Serous microcystic adenoma</a></li> <li><a href="/wiki/Intraductal_papillary_mucinous_neoplasm" title="Intraductal papillary mucinous neoplasm">Intraductal papillary mucinous neoplasm</a></li> <li><a href="/wiki/Pancreatic_mucinous_cystic_neoplasm" title="Pancreatic mucinous cystic neoplasm">Mucinous cystic neoplasm</a></li> <li><a href="/wiki/Solid_pseudopapillary_neoplasm" class="mw-redirect" title="Solid pseudopapillary neoplasm">Solid pseudopapillary neoplasm</a></li></ul> <ul><li><a href="/wiki/Pancreatoblastoma" title="Pancreatoblastoma">Pancreatoblastoma</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Peritoneum" title="Peritoneum">Peritoneum</a></th><td class="navbox-list-with-group navbox-list navbox-odd hlist" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Primary_peritoneal_carcinoma" title="Primary peritoneal carcinoma">Primary peritoneal carcinoma</a></li> <li><a href="/wiki/Peritoneal_mesothelioma" title="Peritoneal mesothelioma">Peritoneal mesothelioma</a></li> <li><a href="/wiki/Desmoplastic_small_round_cell_tumor" class="mw-redirect" title="Desmoplastic small round cell tumor">Desmoplastic small round cell tumor</a></li></ul> </div></td></tr></tbody></table></div> <style data-mw-deduplicate="TemplateStyles:r1130092004">.mw-parser-output .portal-bar{font-size:88%;font-weight:bold;display:flex;justify-content:center;align-items:baseline}.mw-parser-output .portal-bar-bordered{padding:0 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